Maintaining Affordable Health Coverage in Massachusetts Suzanne Curry Health Care For All scurry@hcfama. org Families USA Health Action 2015 January 23, 2015
Massachusetts Health Reform 2006 2
Determining Affordability o Community Catalyst study looked at: ü Greater Boston Interfaith Organization ü Study Mass. FESS (Family Economic Self-Sufficiency Standard) ü Economic Policy Institute Basic Family Budget o Showed people <300% FPL barely have enough income to cover basic needs (before health care costs)
Commonwealth Care o Comprehensive health coverage for adults at or below 300% FPL not eligible for Mass. Health (Medicaid) o Run by the Health Connector (MA marketplace) o Sliding scale premiums based on income, copays also based on income: Plan Types 1, 2, 3 o Cannot be offered health insurance from job o As of December 31, 2013, about 220, 000 enrollees
Why State “Wrap”* Needed ACA Premiums Connector. Care Premiums Income $11, 916 $23, 900 $35, 500 * “Connector. Care”
ACA vs. MA Premiums & Cost Sharing
Connector. Care o Coverage designed to look like Commonwealth Care o Eligibility o Meet eligibility standards for federal APTCs o Income at or below 300% FPL o Must choose from subset of plans offered through the Health Connector (mostly Medicaid MMCOs)
Connector. Care Premiums
Connector. Care Cost-Sharing o Co-pays only; no deductibles or co-insurance o Mirrors actuarial value of Commonwealth Care o Plan Type 1 (at or below 100% FPL): Medicaidlevel co-pays (for prescription drugs only) (~99% AV) o Plan Type 2 (100 -200% FPL): Low to moderate co -pays (~97% AV) o Plan Type 3 (200 -300% FPL): Moderate co-pays (~95% AV)
Connector. Care Funding o Federal APTCs + Federal Cost-Sharing Reductions + State Funds = Connector. Care Subsidies o FY 2015 Budget estimated cost at $235 million o State funding sources include a portion of the cigarette tax, individual mandate penalties, employer assessment o 50% federal reimbursement for premium wrap portion only (for citizens and qualified immigrants) through 1115 Medicaid Demonstration waiver
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