July 2014

July 29, 2014

CMSP Fact Sheet

Auust 1 UPDATE: The House did not take up the CMSP bill on the last day of the formal session, July 31. However, the legislature continues to meet in "informal" session through the end of the year, approving legislation by unanimous consent. Given the bi-partisan support for this bill, we are hopeful that it can be taken up soon during an informal meeting. Contacting legislators is still helpful.


The Massachusetts State Senate voted today to pass a key HCFA bill to improve children's health coverage. The bill has until midnight Thursday to pass the House, before formal legislative sessions end for the year. After that, bills are much harder to pass.

The bill is S.2320, titled, An Act improving the children’s medical security program and simplifying the administration process. Click here for a fact sheet on the bill.

The Children’s Medical Security Plan (CMSP) is a program designed to help kids get the coverage they need, but there are benefit caps that hurt kids. The plan now includes restrictions like a $1,000 cap on emergency medical care. There’s no coverage for basics like eyeglasses or hearing aids. This bill would improve CMSP and ensure that all kids get the coverage they need. The bill would not increase costs for the program, but allow for more flexible benefits to help kids who depend on the program.

The bill passed on a unanimous voice vote in the Senate this afternoon. During today's Senate debate, Senate Republican leader Bruce Tarr praised the bill, saying CMSP "has been a successful health care initiative. This modifies it to strengthen it and adopt it to parameters of the Affordable Care Act." Senate sponsor Sal DiDomenico agreed, saying, "We will provide more effective care and save costs and put those costs in the right places."  Other sponsors include Senator Patricia Jehlen, and Representatives Elizabeth  Malia, Kay Khan, Ruth Balser, Gailanne Cariddi, Cory Atkins, Thomas M. Stanley, Danielle Gregoire, Denise Provost, Sean Garballey, and Denise Andrews.

We urge supporters to call their Representative now to support this bill. To find out how to contact your State Representative, click here.  

 - Jessica Maskin

July 29, 2014

The "Medical Loss Ratio (MLR)" rule is the horrible name for a very good idea - assuring good value for your premiums. The law guarantees that health insurers use almost all of the premium dollars they collect for health care benefits for their subscribers. This has the effect of limiting how much insurers can retain to spend on administrative costs like overhead and marketing.

Under the ACA, insurers in the large group market need to spend at least 85% of their premium revenue on health care, including quality improvements. For the small group and indivudal market, Massachusetts exceeds the ACA standard of 80% by requiring these insurers to spend 90% of their premiums for health care (the 90% standard goes to down to 88% over time).

And here's the best part: if an insurance company fails to meet this standard, it is required to pay the difference in the form of refunds. These refunds can be paid directly to the consumer or paid indirectly through the consumer’s employer.

For Massachusetts, new federal data show that 208,751 insurance customers here will be receiving just over $15 million in rebates for 2013. The largest payers of refunds in Massachusetts are Neighborhood Health Plan, which will return just over $6 million; Fallon Community Health Plan, at $4.2 million; and Tufts HMO, at $2.9 million (see full list by health plan here).

Surprisingly, Massachusetts ranks third in the amount of money refunded to consumers, behind only Florida at $41.7 million and Maryland at $17.3 million. The average refund per family in Massachusetts is $133.

We don't view the MLR rule as a penalty on bad insurers, but as a tool to make sure that premiums are reasonable, even if one has to make after-the-fact corrections. The MLR rule is also causing health insurance companies to lower their premiums, so consumers are saving money even before the refunds. The Federal Department of Health and Human Services estimates that the rule has saved consumers approximately $9 billion since its implementation in 2011. 

In announcing the rebates earlier, Governor Patrick said, "These rebates are all about helping small businesses and consumers reduce their health care costs." We agree.

 - Jessica Maskin


July 27, 2014

The Massachusetts formal legislative session ends every even-numbered year on July 31. So this Thursday is the last chance to pass major legislation before the session ends for the year (of course, there's still opportunities to pass non-controversial matters by unanimous consent in the informal sessions that will continue all year).

For the past 3 sessions, a major health care law was enacted on the very last day of the session. In 2008, it was Chapter 305 (our summary), a cost control law that included restrictions on pharma company marketing, electronic health records, and primary care workforce provisions. It also created a stakeholder commission on payment reform. In 2010, it was Chapter 288, which made numerous reforms to health insurance, including a state Minimum Loss Ratio, open enrollment periods and much more. And in 2012, it was chapter 224, the comprehensive cost control and delivery reform law now being implemented by the Health Policy Commission and others. 

Each of these just made it by the midnight gavel, although, in all honesty, the 2008 law passed a number of minutes past midnight, as the Senate stopped the clock to continue working for another half hour or so (see our tick-tock). Will we get a last-minute health law this Thursday?

Nothing super major is in this wings, so this year might break the pattern. And we do have a good track record for predicting these things.

However, there is an important health care bill that ought to be teed up for passage by Thursday. Both the House and the Senate have passed somewhat different versions of a bill to create an Office of Health Equity with EOOHS. We've been long-time champions of the idea, and drafted the original bill many years ago. The Senate version dropped an important provision that called on the state to conduct an annual "Disparities Impact" review as part of the state budget, looking at the impact on disparities of major inititives of the state. We hope the House and Senate can quickly come to an agreement on the bill. Passage on July 31 would be a nice way to uphold the tradition.

  -Brian Rosman

Cameras on the Kids Count Press Conference
July 24, 2014

This week, we were proud to participate in the release of the Kids Count report, placing Massachusetts at number one in the nation when it comes to overall child well-being. The Annie E. Casey Foundation report covers a wide spectrum of data when it considers children’s wellbeing, and of course access to health care is one of the main metrics in addition to early education, child poverty, and more. With just only about 1% of children uninsured, Massachusetts does extremely well on access to coverage.

The report says that “Children have a greater opportunity to thrive and succeed in Massachusetts than in any other state,” according to our friends at the Mass Budget and Policy Center. You can read MassBudget’s full report here.

But there is more work to do. One in seven -- seven -- children in Massachusetts live in poverty. That number is too high. Governor Patrick spoke passionately about the work that lies ahead. “The question before the Commonwealth, and the country, isn't what to do - we know what to do,” said Governor Patrick. “The question is whether we mean what we say, whether all means all - opportunity for all, equality for all, a fair chance for all.  If we mean it, then we have to do the things we know work." To see the Governor’s full remarks, watch his YouTube clip.

Our Executive Director, Amy Whitcomb Slemmer had this to say: "The Commonwealth's focus and forward-thinking financial investments are paying off for our children. Covering 99% of our children with health insurance as part of our commitment to providing comprehensive, affordable, accessible high quality care for all is unprecedented and unparalleled in the country.”

The facts are clear that despite our number 1 ranking, we are far from finished nationwide or at home. There is a national poverty gap that breaks along racial and ethnic lines. In America, 40 percent of black children and 34 percent of Hispanic children live in poverty while 14 percent of white children do.

In Massachusetts, despite having almost universal access to health care, there are other health concerns. For example, Massachusetts children are about as likely to abuse drugs and alcohol as kids anywhere else in the country. And we know that no issue is separate -- all the issues are interconnected. How well a child does in school often depends on his or her health, for example. 

As Amy Whitcomb Slemmer said: “The Kids Count report also highlights the work yet to do. We must close the gaps for non-English speaking children and for immigrant communities across the Commonwealth. We must uproot the entrenched causes of poverty that make being born in certain zip-codes a health hazard.  We must continue to push so that our world class health delivery system to which nearly every child in Massachusetts has access, translates into having the healthiest children in our nation."

The report garnered a lot of press coverage, and you can read just some of the coverage here. Again, Health Care For All is proud of Massachusetts’ number 1 status. It did not happen by accident. We got to where we are because of hard work, a commitment to universal health coverage, early education, and more. Now the work continues to make sure that we lift all children out of poverty to ensure that they lead the healthiest, happiest lives possible.

--Ari Fertig

July 18, 2014

“We have succeeded in covering millions of people – now we have to keep them covered” was a message we heard numerous times throughout Enroll America’s State of Enrollment conference.  The days at #SOE2014 were jam-packed with informative workshops and plenaries offering innovative, creative, and experience-driven ideas about how to successfully engage the remaining uninsured and keep those that have enrolled covered. And we know Navigators, Certified Application Counselors (CACs), and other assisters will be critical to ensuring this work is done and done right!

Here are some of our key takeaways to helping consumers keep coverage that we brought back to Massachusetts:

  • Less is more — It is essential that people know that they need to renew their coverage and how to complete the process. However, it is also important not to overwhelm people with too much information during the initial conversation about renewing or changing coverage.
  • See every interaction as an opportunity — Just as every change in a household could cause a gap in health care coverage, every contact with a consumer is an opportunity to remind people about the need to update their marketplace account with any information about life changes and to review their coverage every year to ensure successful renewal.
  • Meet people where they are — Borrow an existing audience rather than trying to build one, and use it as an opportunity to educate folks about getting covered and staying covered.
  • Fight against churn — Accidental gaps in coverage may happen, but they are something we all have to work to combat. It’s the only way to ensure people can consistently access the health care services they need!
  • Think creatively about retention — Many states are using unique strategies to combat coverage gaps or disenrollments. For example, Massachusetts offers Navigators, CACs, and other assisters the opportunity to receive carbon-copy notices of renewal that are sent to applicants they have assisted. This allows them to make outgoing calls and to send texts and emails to their clients reminding them that it’s time to renew.

#SOE2014 was a first-of-its-kind event convening hundreds of health care stakeholders committed to health coverage enrollment and retention. The opportunity to learn from and share promising and best practices with so many informed people from all over the country was informative and exciting. There’s no doubt that the takeaways we brought back to Massachusetts will ensure that hundreds of thousands of people get, and stay, covered during the upcoming open enrollment period!

-Kate Bicego and Hannah Frigand

Crossposted to Enroll America's blog here.

Connector Slide on Key Benefits of Hix plan 7-10-14
July 13, 2014

Thursday’s Health Connector Board meeting was jam-packed with important agenda items, including:

  • Health Insurance Exchange (HIX) Project Update;
  • Conditional 2015 Seal of Approval;
  • Health Connector Fiscal Year 2014 and 2015 Administrative Budgets; and
  • Dell Work Orders.

It's clear that the Connector staff is pleased with the progress being made towards "standing up" (their phrase) the website and eligibilty system for the fall open enrollment. New health reform czar Maydad Cohen has confidently mastered the complex details of the ongoing work.  Still, there are real risks, and they continue to ruthlessly prioritize only critical tasks. We were particularly pleased to hear that the system will include a single entry point and a common application for all subsidized health insurance programs. This will reduce confusion among people who generally do not know which program they may be eligible for in advance of applying.

Materials from the meeting are posted on the Connector's site. Our detailed report is just a click away.


HIX Project Update


Summary of progress on dual-track

As we reported in earlier posts (here and here), the Health Connector is working on a ‘dual-track’ strategy to build a new website and underlying eligibility and enrollment system. One track is utilizing and customizing “off the shelf” software from hCentive. The other track is focusing on linking up with the Federally Facilitated Marketplace (FFM, or healthcare.gov), and is required by CMS as a contingency plan should hCentive not be ready to go live in November. Not to be overlooked, the eligibility system revamps also include MassHealth’s implementation of a new eligibility system that is capable of making program determinations using new income methodology required under the Affordable Care Act (ACA). Both hCentive and the FFM would need to utilize the new Medicaid system.

The hCentive system was first installed for testing on June 30th. Maydad Cohen, the Special Assistant to the Governor for Project Delivery, reported that the hCentive system successfully passed its first test with the Centers for Medicare and Medicaid Services (CMS). As such, CMS gave Massachusetts permission to continue on the ‘dual track’ strategy – continue to develop hCentive and prepare the Connector to hook up with the FFM. Thus far, the Connector has focused on common work that can be used for both hCentive and the FFM. After the success of the first hCentive release and the needs of each project diverging, Cohen stated that the state will be managing the FFM project budget more tightly.

The second release of hCentive – expected for July 30th – is on schedule. This version will include the ability to make determinations and show appropriate plans for ConnectorCare, the state wrap program, and assess MassHealth eligibility. The Health Connector and CMS established early August as the decision point to move to a single track.


Steps and Status of Consumer Experience under new eligibility system 7-10-14


An important gain for consumers has been made ahead of schedule – a single “front door” to apply for coverage for residents seeking unsubsidized or subsidized coverage through the Health Connector and for those applying for MassHealth. Initially, the Connector and MassHealth thought consumers would have to choose between two “front doors” to apply for coverage – one for Health Connector coverage and one for MassHealth coverage.

MassHealth is also making significant headway with the MassHealth Eligibility Platform (MEP), the tool that will be used to make Modified Adjusted Gross Income (MAGI)-based MassHealth eligibility determinations. MEP is based in the HIX/IES system developed by the previous vendor, CGI. Importantly, hCentive (and the FFM) and MEP need to be able to communicate with each other. Particularly with a single front door, hCentive needs the ability to make account transfers to MEP and MEP needs to communicate back to hCentive to let it know what its program eligibility decision was. From there, it is envisioned that hCentive will be the application system of record and will handle case management.

The FFM track is also making significant progress. In the event that Massachusetts needs to use the FFM for Fall 2014 open enrollment, the Health Connector would remain a State-Based Marketplace (SBM) with the continued authority to oversee health plan certification, risk adjustment, outreach, and other functions.

July 9, 2014

Overview of Partners - Hallmark transaction

The Health Policy Commission (HPC) met on Wednesday, July 2nd, 2014 to cover a packed agenda of HPC activities including a preliminary report on the Cost and Market Impact Review (CMIR) of the proposed Partners acquisition of Hallmark Health System and a discussion around the Commission’s comments to the Attorney General and Partners final resolution currently in front of Suffolk Superior Court judge, Janet L. Sanders. The Commission posted its slides from the meeting. Keep on reading on for a summary of the agenda points and discussion.

July 1, 2014

Our friend and Board member Chip Joffe-Halpern wrote a column for the Berkshire Eagle (State health reform for the long haul), explaining some of the challenges and successes in Massachusetts’ implementation of the Affordable Care Act. Chip runs Ecu-Health Care, a non-profit which helps the uninsured and underinsured residents of North Berkshire access affordable health care.

His op-ed today puts into context where we are, and where we are going. He concludes that, “Massachusetts has implemented policies that go beyond the federal guidelines and will more effectively achieve the objectives of the Affordable Care Act.” Here’s Chip:

Massachusetts has struggled implementing the Affordable Care Act, highlighted by a problematic computer system and an inability to process thousands of applications. Given that Massachusetts pioneered near universal coverage with its 2006 landmark health care law, the state has received much criticism for its inability to make the changes needed to accommodate the federal health coverage expansion.

Massachusetts has not received the recognition it deserves though, for taking important steps that augers well for the long-term success of health reform.

When it became apparent the computer problems could not be easily solved, the state decided to enroll over 227,000 individuals in temporary health insurance. Health coverage was also extended to an additional 100,000 individuals who were previously enrolled in the state's Commonwealth Care and Medical Security Plan health insurance programs, Massachusetts has received approval to extend coverage for these individuals through December 31, 2014.

oing forward, Massachusetts is also keeping health care cost sharing at affordable levels for individuals and families with incomes under 300 percent of the 2013 federal poverty guidelines ($34,476 for one, $70,656 for four). These individuals will be eligible for MassHealth, or Connector Care, a health insurance that has no annual deductibles. ConnectorCare members will also receive additional assistance to lower the cost of health insurance premiums and cost-sharing so that costs are similar to what individuals currently pay under Com monwealth Care.

The Affordable Care Act embraces the principle that all Americans deserve affordable health coverage. While the federal law includes cost-sharing support for individuals whose incomes are under 250 percent of the federal poverty guidelines, each state has the latitude to implement policies that will determine both the cost of health insurance premiums and the amount of cost sharing for individuals who will qualify for assistance under the federal law.

Chip is so right on. Read the entire explanation here

-Ari Fertig