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Massachusetts Health Reform A Social Compact for Shared Responsibility
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Massachusetts Health Reform A Social Compact for Shared Responsibility State Coverage Initiatives January 26, 2007 Christie L. Hager, J.D., M.P.H. Chief Health Counsel Office of Speaker Salvatore F. DiMasi
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Massachusetts Health Reform A Social Compact for Shared Responsibility State Coverage Initiatives January 26, 2007 Christie L. Hager, J.D., M.P.H. Chief Health Counsel Office of Speaker Salvatore F. DiMasi. Social Compact. “ Voluntary association of individuals… - PowerPoint PPT Presentation
Transcript of Massachusetts Health Reform A Social Compact for Shared Responsibility
Massachusetts Health Reform A Social Compact for Shared
Responsibility
State Coverage InitiativesJanuary 26, 2007
Christie L. Hager, J.D., M.P.H.Chief Health Counsel
Office of Speaker Salvatore F. DiMasi
State Coverage Initiatives January 26, 2007
“Voluntary association of individuals…
... all shall be governed by certain laws for the common good.”
Social Compact
Source: Preamble, Constitution of the Commonwealth of Massachusetts
State Coverage Initiatives January 26, 2007
Health Reform by the Numbers
Sections of Chapter 58 of the Acts of 2006 .....147
Chapters of the MGL amended…………..……22
State entities affected or created…....................19
Residents of the Commonwealth expected to become insured over the next 3 years.......515,000
State Coverage Initiatives January 26, 2007
– MassHealth Expansion and Restorations– Subsidized Health Insurance
― Commonwealth Care Health Insurance Program
― Commonwealth Health Insurance Connector
– Uncompensated Care Pool / Health Safety Net
– Medicaid Provider Reimbursement– Quality and Cost-Effectiveness – Private Health Insurance Market Reforms– Employer Responsibility – Individual Mandate– Public Health – Health Disparities
Chapter 58 of the Acts of 2006
State Coverage Initiatives January 26, 2007
Employer Responsibility
Fair Share Contribution
Section 125 “cafeteria plan”
Free Rider Surcharge
Health Insurance Responsibility
Disclosure
Anti-discrimination in offer
State Coverage Initiatives January 26, 2007
Fair Share Contribution
“Fair and reasonable” premium contribution defined and calculated by Division of Health Care Finance and Policy
Collected by Division of Unemployment Assistance
State Coverage Initiatives January 26, 2007
Section 125 Cafeteria Plan1 Offer
Effective January 1, 2007
Section 125 cafeteria plan to be filed with the Connector
AG enforcement and authority to seek injunctive relief
Proposed regulations expected February
1 26 USC 125
State Coverage Initiatives January 26, 2007
Free Rider Surcharge
# of Employee free care visits per year
# of Employees
4-6 (1 employee) OR
5-10 (all employees)
7-14 OR
11-20
>15 OR >20
11-20 10% 20% 30% 40%
21-35 15% 25% 35% 45%
36-50 20% 30% 40% 50%
>50 25% 35% 45% 55%
If no 125 offer AND
Employee or dependent uses free care 3x in a single yearOR
Employer has aggregate of 5 or more uses in a single year:
Non-compliance with HIRD requirement OR second successive year of surcharge
State Coverage Initiatives January 26, 2007
Individual Responsibility
Effective July 1, 2007 Affordability schedule set by Connector Penalty in tax year ’07 - loss of
personal exemption Penalty in tax year ’08+ - 50% of
monthly affordable premium Religious and hardship exemptions Appeals through Connector Health Insurance Responsibility
Disclosure
State Coverage Initiatives January 26, 2007
Commonwealth Health Insurance Connector Authority
www.mass.gov/connector
State Coverage Initiatives January 26, 2007
Commonwealth Care Health Insurance Program
Sliding-scale subsidies to individuals with incomes below 300% FPL ($29,400 for an individual; $49,800 for a family of 3)
No premiums for people with incomes below 100% FPL ($9,800 for an individual)
No deductibles
Comprehensive benefits
State Coverage Initiatives January 26, 2007
Connector Determinations
Affordable products for >300% FPL (Commonwealth Choice)
Minimum Creditable Coverage
Definition of affordability
Waiver and appeals process
State Coverage Initiatives January 26, 2007
Implementation Timeline
State Coverage Initiatives January 26, 2007
29%
40%
17%14%
Individual Mandate(>600%
FPL)
Affordable Products for non-CCHIP(301-600%
FPL)
MassHealth Expansion
Commonwealth Care
(≤300% FPL)
Coverage Estimates
