Transcript Massachusetts Health Care Reform and Adult Members with

Massachusetts Health Care Reform and
Adult Members with Disabilities
Annette Shea, MEd
and Jay Himmelstein MD, MPH
University of Massachusetts Medical School
Center for Health Policy and Research
Disability and Employment Policy Research Group
November 9, 2009
Agenda
• Overview of Massachusetts Health Care Reform
• MassHealth and “CommonHealth”: The Massachusetts
Medicaid Buy-In program
• Health Reform and Medicaid - Lessons learned
• Implications for PWD and Medicaid Buy-in programs
• Discussion
Massachusetts Health Care Reform of 2006:
Key Elements
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Created “Connector Authority” – Board and Insurance Exchange
MassHealth (Medicaid) Expansion - Expansion of financial rules for nondisabled categories
New insurance options for legal residents who are not eligible for other
public or employer-sponsored health insurance:
– Completely subsidized, comprehensive health insurance to adults
earning up to 150% of the federal poverty level (FPL).
– Commonwealth Care – subsidized insurance for those less than
300% FPL
– Commonwealth Choice – offered through Connector Authority,
links individuals over 300% of FPL with health insurance
Reforms to the commercial market
Individual Mandate
Employer “fair share” assessment for those with 11+ full-time equivalent
employees.
The Massachusetts Health Connector
• An independent state agency which helps Massachusetts
individuals and employers get more affordable health insurance
coverage.
– Provides low or no-cost health insurance to qualified residents
(Commonwealth Care).
– Works with insurance companies to create new health
insurance choices for individuals and employers
(Commonwealth Choice).
• The Connector Board also granted authority to make key decisions
with regard to Minimal Creditable Coverage (MCC), affordability,
waivers to individual mandate, and other aspects of health reform
implementation
Massachusetts Health Reform:
Three Years Later
• Status
– Estimate of over 400,000 newly insured
– Rate of un-insurance in MA estimated at 3%, compared to
the national average of 15.5%
– 99,000 more MassHealth members
– 160,000 Commonwealth Care members
• Challenges
– Costs are somewhat higher than expected
– Keeping insurance costs affordable will require substantial
changes
– Impact of National Health Reform?
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MassHealth (Medicaid) and MA Health Reform
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MassHealth - The Massachusetts Medicaid Program
– Administered under an 1115 Waiver Authority
– More than 1.2 million residents enrolled
– 200,000 members with disabilities age 19-64
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MassHealth and Health Reform:
– Centralized enrollment process: Use of the state’s Medicaid
(MA21) eligibility system to process application for subsidized
health programs.
– Use of the state’s Medicaid (MA21) eligibility system to process
applications with built-in logic to enroll applicants in the “richest”
benefit category of assistance.
– Applicants with disabilities continue to have same access to
established MassHealth plans for members with disabilities.
– Applicants with disabilities not eligible for MassHealth, without
comparable coverage, i.e. Medicare, have access to
Commonwealth Care and Commonwealth Choice.
The Massachusetts Medicaid Program:
CommonHealth
• CommonHealth is the Massachusetts Medicaid Buy-In Benefit Plan.
• CommonHealth was created a state program as part of the Dukakis
Universal Health Care Act of 1988.
• CommonHealth included under State 1115 Waiver as of 1997.
• Currently, more than 20,000 Medicaid Buy-In enrollees in 3
subgroups:
– 12,000 CommonHealth Working Adults age 19+
– 5000 CommonHealth Non-Working Adults age 19-64
– 3000 CommonHealth Children <19
• Note: the CommonHealth Working Adults program (“Buy-in”) requires
40 hours work/month and has no income limit or asset test.
The Massachusetts Medicaid Program:
Plans for People with Disabilities
Eligibility Criteria
MassHealth Standard
CommonHealth
Working
CommonHealth
Non-Working
Age
19 - 64
19 or older
19 - 64
Financial criteria (household
income: member and spousal
income where applicable)
At or below 133%
Federal poverty level
Above 133% federal poverty
level
Above 133% federal poverty
level
Work Status
Could be working
Working 40 hours or more
each month
Not working or working less
than 40 hours each month
Disability
Determined by Social
Security (SSA) or MassHealth
Determined by SSA or
MassHealth
Determined by SSA or
MassHealth
Needs Test
None
None
One time spend down will
apply
Premium
None
Based on family size &
monthly household income
Based on family size &
monthly household income
Asset Test
None
None
None
Redetermination
Annually
Annually
Annually
Massachusetts Health Care Reform
Access for People with Disabilities
• Massachusetts took specific measures to ensure ongoing
access to programs for people with disabilities.
– Single application for MassHealth and subsidized plans
– Centralized eligibility and enrollment process
– No change for MassHealth members with disabilities
• Members with disabilities continue to have access to
MassHealth plans which offer community long-term care
services not provided by private insurers or Medicare.
– Access can include enrollment in multiple plans with
MassHealth as wrap coverage.
Massachusetts Health Care Reform
Impact on People with Disabilities
• Some adult applicants with disabilities age 19-64, may be
enrolled in either Commonwealth Care or Commonwealth
Choice plans if:
– Their household income exceeds the MassHealth
Standard threshold of 133% FPL, and
– They are not working 40 hour or more each month, and
– They do not have access to comparable coverage like
Medicare or private insurance.
• Commonwealth Care and Commonwealth Choice plans do
not offer community long term care services like personal care
attendant services.
Factors Contributing to Success in
Massachusetts
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Massachusetts had an established Medicaid program for people
with disabilities, age 19-64, with a 133% FPL financial eligibility.
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The CommonHealth Working (MBI) has work requirement, an
income related premium but no income limits or asset test.
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Massachusetts negotiated with CMS to ensure existing Medicaid
programs for people with disabilities would remain intact.
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Focus on outreach and centralized enrollment systems provided
increased access to information for applicants and members.
– Same application and state’s Medicaid (MA21) eligibility
system used to process applications for subsidized health
programs.
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Multiple mechanisms for program enrollment
– Standard application available on web
– Use of Virtual gateway by providers and community groups
Health Care Reform: Implications for People
with Disabilities and Medicaid Buy-Ins
• The impact of the state and national health reform will vary
dependent upon each state’s existing Medicaid and MBI
programs.
• Emphasis on outreach and centralized enrollment systems can
facilitate access to information for applicants and relatively
smooth transition for members.
• Non-Medicaid “Insurance Exchange” products may need to take
on cost and care needs of people with disabilities.
Questions?
Annette Shea, MEd
Senior Project Director for Medicaid Disability and
Employment Initiatives
[email protected]
508-856-2654
Jay Himmelstein MD, MPH
Professor, Family Medicine and Community Health
Director, Massachusetts Medicaid Infrastructure and
Comprehensive Employment Opportunities Grant
[email protected]
508-856-5763