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Expanding Health Insurance Access

April 7, 2006

"An Act Providing Access to Affordable, Quality, Accountable Health Care": An Outline of the Bill's Provisions

Medicaid

Expands eligibility for children up to 300% Poverty Level, e.g., $48,000 annually for a family of three (27,000 individuals)
Expands outreach to currently eligible but unenrolled adults (40,000 individuals)
Raises enrollment caps on MassHealth Essential, CommonHealth, and MassHealth HIV (18,000 individuals)

Commonwealth Care Health Insurance

A new initiative that provides Medicaid-like private insurance coverage:

To uninsured adults below Poverty Level, e.g., $9,700 for an individual, requiring no monthly premiums or deductibles (65,000 individuals)
To uninsured adults up to 300% Poverty Level with sliding-scale premiums schedule (150,000 individuals)

Insurance Partnership Program

Expands eligibility for employee participation up to 300% Poverty Level (7,500 individuals)

"Individual Mandate"

Requires all individuals to have coverage by July 1, 2007, so long as affordable coverage is available

"Employer Mandate"

(see: "Paying the Bill Over the Next Three Years" section below)

Making Coverage More Affordable

Establishes Commonwealth Care Health Insurance Connector

A new public authority

To connect individuals and employers to private coverage (215,000 individuals)
To allow purchase of insurance with pre-tax dollars
To encourage insurance companies to offer low-cost products, including products for young adults (to age 26)
To market products to small businesses and reduce administrative costs
To certify quality of plans offered

Other Affordability Provisions

Merges small and non-group markets (lowering individual costs by 25%)

Allows independent young adults to stay on family plans (for 2 years or to age 25)
Moratorium on new mandated benefits until January 1, 2008

Increasing Medicaid Reimbursements

For Physicians

$81 million in additional funding provided to physicians in escalating amounts over a three-year period

For Hospitals

$459 million in additional funding provided to hospitals in escalating amounts over a three-year period ($382.5 million in last two years linked to performance)

Addressing Health Care Quality and Cost Issues

Health Care Quality and Cost Council

To collect data from health insurers and providers
To set quality improvement and cost containment goals and benchmarks
To establish a consumer health information website with comparative data for consumers
With Advisory Committee (including MMS)

MassHealth Payment Policy Advisory Board

To review and evaluate rates and payment systems
With MMS membership

Invests in Computerized Physician Order Entry System

$5 million in implementation support for e-Health Collaborative

Expanding Public Health and Prevention Initiatives

Additional Funding for Public Health Programs

$14.5 million in additional funding, including tobacco control, breast and prostate cancer screening, teen pregnancy prevention, pediatric palliative care
Study of role of community health workers with Advisory Council (including MMS)

Additional Initiatives to Enhance Health of Medicaid Patients

Restores adult oral health, eyeglasses and other benefits
$7 million for new smoking cessation benefit (two-year pilot)
"Wellness Program" established, including smoking cessation, diabetes screening, teen pregnancy prevention, cancer screening, stroke education

Reducing Racial and Ethnic Disparities

Establishes Health Disparities Council

To make recommendations on reducing disparities in care and outcomes
With MMS membership

Restructuring the "Safety Net"

Replacing the Uncompensated Care Pool

With new Safety Net Care Fund in Medicaid Office as of October 1, 2007
Establishes standardized fee schedules to assist community hospitals
Provides support for Boston Medical Center and Cambridge Health Alliance to ease transition from current system to new Safety Net Care Fund

Meets the terms of the federal waiver agreement to secure $385 million in federal funds

Paying the Bill Over the Next Three Years

Continued Federal Funding

Federal "Safety Net" Revenues ($605 - $610.5 million annually)
Federal Medicaid Matching Revenues ($184.6 - $299.6 million increasing annually)

Continued "Pool" Assessments

Hospital Assessment ($160 million annually)
Surcharge Payer Assessment ($160 million annually)

Employer Payments (new)

"Fair Share" Assessment ($45 to 22.5 million declining annually)
- On employers of 11 or more employees not offering coverage
- Assessment of up to $295 per full-time equivalent employee per year, pro rated for temporary and seasonal employees working at least 30 days"Free Rider"
Surcharge ($50 to 25 million declining annually)
- On employers of 11 or more employees not offering coverage, if "free care" is accessed at least 5 times annually (or 4 times by a single employee)
- Surcharge is 10 to 100% of cost to state after first $50,000 in aggregate costs

General State Revenues (new)