Transcript wraps around federal premium and cost-sharing

Maintaining Affordable Health
Coverage in Massachusetts
Suzanne Curry
Health Care For All
[email protected]
Families USA Health Action 2015
January 23, 2015
Massachusetts Health Reform 2006
2
Determining Affordability
o Community Catalyst study looked at:
 Greater Boston Interfaith Organization
 Study MassFESS (Family Economic Self-Sufficiency
Standard)
 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 MassHealth (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
ConnectorCare
Premiums
Income
$11,916
$23,900
$35,500
* “ConnectorCare”
ACA vs. MA
Premiums & Cost Sharing
ConnectorCare
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)
ConnectorCare Premiums
ConnectorCare 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)
ConnectorCare Funding
o Federal APTCs + Federal Cost-Sharing Reductions +
State Funds = ConnectorCare Subsidies
o FY2015 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
Thank you!
Questions?