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Connector Looks Ahead, and Gets New Head

Connector Looks Ahead, and Gets New Head

February 12, 2015

Connector summary slide 2-12-15

The Health Connector Board met today.  With open enrollment for Connector plans (but not MassHealth) ending in on Sunday, there was lots of talk about accomplishments and challenges.  An affordability schedule (that also sets parameters for subsidized premiums) was preliminarily approved, continuing our long-standing approach to what is considered affordable. It was the first Connector board meeting for their new Executive Director, and, oh, and there's a new Chair of the Connector Board, as the Baker administration creatively used some flexibility in the statute to reshuffle the leadership and membership of the Board a bit.

Under the law establishing the Connector, the Board Chair is the the Secretary for Administration and Finance (ANF), or his or her designee. Also on the board are the Director of Medicaid and the Commisioner of Insurance, or their designees. Today,  ANF Secretary Kristen Lepore designated Executive Office of Health and Human Services (EOHHS) Secretary Marylou Sudders to serve in her place, and thus be the board chair. Then in turn,  the new Assistant Secretary for MassHealth, Daniel Tsai, designated ANF Secretary Kristen Lepore to represent MassHealth on the Board. So in sum, MassHealth is out, EOHHS is in, and is the new chair. Secretary Sudders noted that part of the thinking behind the change is that “it is the Governor’s expectation that health care and finance be equally considered.” (Although, for today's meeting, Secretary Lepore was represented by her Director of Health Care Policy, Lauren Peters, as a designee's designee.)

Secretary Sudders welcomed Louis Gutierrez to his first Board meeting as the Executive Director of the Health Connector. Gutierrez noted the accomplishments so far with the new IT system – over 325,000 Massachusetts residents enrolled in MassHealth and Connector coverage since the beginning of open enrollment (November 15th). As of yesterday, the 102,169 are enrolled in Health Connector health plans and 22,769 people enrolled in dental plans.

Gutierrez also thanked Maydad Cohen, whose last day as special assistant to the Governor for Project Delivery is March 6th, his team and the Health Connector team for their work in getting to this point. Gutierrez also said that the Connector will continue to have the same dedication to getting health coverage for Massachusetts residents as they have had during open enrollment, and hopes the changes to the Board structure will enable the “Health Connector and MassHealth to independently work seamlessly toward coverage.”

With all that taken care of, the meeting materials are here, and click on for our full report:

Open Enrollment & System Update

Maydad Cohen provided a look back at where the Health Connector started with ACA implementation, where they are now and where they are headed.

Where we started” - We all know the last year has been challenging, and the Connector and MassHealth had to scrap a broken website and start over and address a paper application backlog, both of which led to consumer anxiety and frustration.

Where we are” - The IT system is currently stable and able to handle high numbers of simultaneous users, allow people to apply and shop for coverage. Nearly 340,000 people have enrolled in ACA-compliant coverage since November 15th. The Connector will be focusing immediately on improving customer service and the online payment system.

People have until this Sunday, February 15th to apply and choose a plan and until February 23rd to pay their premium for coverage effective March 1st. The Health Connector is extending customer service call center hours during this last push during open enrollment and will be offering additional support at their Boston walk-in center at 133 Portland St.

Health Connector customer service call center (1-877-623-6765)

Thurs. 2/12- Fri. 2/13: 7am-9pm
Sat. 2/14-Sun. 2/15: 7am-7pm
Mon. 2/16 (Presidents’ Day): 9am-3pm
Tues. 2/17-Fri. 2/20: 7am-7pm
Sat. 2/21-Sun. 2/22: 9am-3pm

Mon. 2/23: 7am-9pm
Tues. 2/24-Fri. 2/27: 7am-7pm
Sat. 2/28: 9am-3pm

133 Portland St., Boston walk-in center

Fri. 2/13: 9am-6pm
Sat. 2/14-Sun. 2/15: 9am-3pm

The Health Connector will also add 35 new customer service representatives to help address the call volume and wait times. The Connector is also working with MassHealth to plan for handling calls from MassHealth members who need to renew their coverage.

As for the online payment system, which has caused many consumers frustration, the Health Connector has developed step-by-step guides on how to make online payments and is currently working on integrating the payment portal into the eligibility and enrollment system itself (right now it is a separate website).

“What’s next” - The Health Connector will work with MassHealth to ensure a positive experience for the 1.2 million MassHealth members who need to renew their coverage (this is on top of the consumers who already needed to act during open enrollment). The Connector seeks to use the following principles to guide their work moving forward:

  • Expand access to affordable, quality health care and continue the Commonwealth’s national leadership on health care reform
  • Leverage world-class technology to professionalize Health Connector and MassHealth customer service and marketplace operations
  • Require top notch and cost effective services from all contractors, including call center vendors
  • Promote public transparency, accountability and collaboration

Outreach and Education for 2015 Open Enrollment

The Health Connector’s goal for this open enrollment period was to reach more than 500,000 individuals in the target transition populations – including Qualified Health Plan, Commonwealth Care, and temporary MassHealth members. The outreach campaign has been successful, with over 4 million website visits, 450,000 eligibility determinations and 338,000 enrollments to date.

The outreach campaign included the following strategies:

  • 1.7 million outbound calls
  • 1.3 million pieces of mail sent
  • 42.2 million internet advertisements
  • 9,500 as run via print, radio and TV
  • 388,000 doors knocked (by Health Care For All and our community partners)
  • 4 enrollment events and 6 walk-in center events
  • 1,400 navigators and certified application counselors

The Health Connector will continue these strategies with partner organizations to encourage as much application and enrollment activity through the end of open enrollment. As stated earlier by Maydad Cohen, the Connector will have extended call center and walk-in center hours. The Connector Board voted favorably to extend a work order with Dell, the Connector’s customer service vendor, in order to support these extended hours and 35 new staff.

Even after the ACA open enrollment period ends, the Health Connector and MassHealth will continue to outreach to populations who need health coverage, through targeted campaigns using a mix of direct-to-consumer outreach and work in particular ethnic communities.

2015 & 2016 Affordability Schedules

As a refresher, the Commonwealth decided to maintain the state individual mandate – the requirement to have health insurance if it is affordable to you – in addition to the federal individual mandate required under the Affordable Care Act. Therefore, the Health Connector retains its role in setting the state Affordability Schedule for purposes of determining penalties for those who remain uninsured under the state individual mandate.

The Health Connector is developing the 2015 and 2016 Affordability Schedules at once in order to set the schedules in advance of the annual Seal of Approval process, which now takes place on a calendar year basis as opposed to a fiscal year (as it did under the Commonwealth Care program).

The Health Connector has used a step-by-step process to align the approach to the state Affordability Schedule with that of the federal affordability standards.

  • Step 1 (2013): continued to mirror the flat dollar amount premiums offered through the Commonwealth Care program for people at or below 300% FPL, started moving higher income people down towards the federal 8% standard, and instituted a 10% cap for the highest income people.
  • Step 2 (2014): continued using Commonwealth Care premium amounts for people at or below 300% FPL, adopted 8% -of-income standard for people above 400% FPL, and adopted a mid-way point between the 2013 schedule and 8% for people between 300-400% FPL.
  • Step 3 (2015): In this final step, Health Connector staff propose moving to a completely percentage-based schedule, rather than using flat dollar amounts.

For 2015, this means:

  • Up to 300% FPL: Percentage standard based on ConnectorCare premiums
  • 300-400% FPL: Percentage standard based on the average percentage of income represented by fixed dollar amounts in previous Affordability Schedules
  • Over 400% FPL: 8.05% of income to align with the federal standard

For 2016, the Health Connector proposes to update the standards as such:

  • Up to 300% FPL: Converting flat dollar amounts from 2012 Commonwealth Care premiums into percentages using the updated 2015 federal poverty guidelines
  • 300-400% FPL:  Adjusting brackets up slightly from 7.4% to 7.6%
  • Over 400% FPL: Adjust cap to 8.3% to align with the federal standard

The thinking and its implications are described in this detailed memo.

Connector Board member Nancy Turnbull expressed concerns with using the federal method of indexing percentage of income, which results in people whose income has not changed required to pay more towards premiums. Jon Gruber responded that indexing is a way of sharing the increase in health care costs between the government and consumers. He went on to say that keeping the percentage of income below 300% FPL constant while following the indexing approach for consumers above 300% FPL increases the “jump” in the percentage of income required for those over 300% FPL. Gruber requested that the Connector staff and Board revisit whether it is acceptable to have different standards for those below 300% FPL and for those above that income threshold.

Gruber also suggested the Board consider how to make the development of the Affordability Schedule more automated instead of revisiting it every year. Turnbull added in saying that the increase in percentage of income required between 2015 and 2016 is highest for people at the lowest income levels.  Dolores Mitchell stated that the Connector needed to keep in mind that the cost of health care cannot legitimately go up every year – “part of our job is to address why health care costs so much and to do something about it.”

With that, the Connector Board voted unanimously to release the proposed 2015 and 2016 Affordability Schedules for public comment, and will vote on the final schedules in the coming months.

The next Connector Board meeting is scheduled for Thursday, March 12th at 9:00am, One Ashburton Place, 21st Floor, Boston.

          - Suzanne Curry