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More Building Blocks For ACA Implementation

More Building Blocks For ACA Implementation

May 4, 2013

Governor Patricks cover letter filing the ACA implementation bill

While ACA implementation remains contentious in many states, in Massachusetts the building blocks are being set in place in a routine and orderly way.

On Wednesday, MassHealth released its revised ACA implementation plan, called the "Roadmap to 2014." Also released was the state's proposal to the federal CMS for an extension of our Medicaid waiver, along with supporting documents (the materials can be found on the MassHealth waiver documents webpage).

And this afternoon, Governor Patrick filed legislation needed to implement the ACA in Massachusetts (here's the bill, H. 3452, the state's section by section summary; and here's their summary by topic).

The Governor's cover letter sets out why he is looking for passage of the law:

The legislation will allow Massachusetts to realize the full benefits of the Affordable Care Act, including expanded federal funding to support coverage for low and middle-income families and federal insurance reforms that will secure additional protections for Massachusetts residents.

The bill proposes a number of technical changes to state insurance laws to conform with the ACA. Many of these changes will improve access to coverage. For example, current law prohibits individuals from buying individual coverage if they have access to employer-based insurance. The ACA does not allow these restrictions, so the bill eliminates the provision. Another section of the bill extends the ability of adult children up to age 26 to remain on their parent's coverage, because the federal law is more expansive than our provision, enacted as part of Chapter 58. The bill also eliminates obsolete references in current law to pre-existing conditions and waiting periods, and permits the phase-out of rating factors not allowed by the ACA (explanation).

Other sections of the bill revamp the MassHealth and Connector statues to reflect the new subsidized insurance program starting in 2014. Statutory provisions for Commonwealth Care, Masshealth Essential, the Insurance Partnership program, and other programs are eliminated, replaced by expanded MassHealth eligibility.

The legislation will need to be enacted within the next few months in order to get state laws in place for implementation by insurers and others. The legislature should move quickly on the bill, which will be tough given the difficult budget and revenue issues still to be resolved.

At the same time, the state is asking the federal government to renew the "1115 Waiver" agreement with the federal government (background, and more, from BCBS Foundation). The waiver would permit Massachusetts to receive federal Medicaid funds for some of the cost of health reform programs, including funding for the "QHP Wrap" which is the state's supplement to federal premium and cost sharing subsidies. The goal of the wrap would be to prevent increases in costs for low-income people in the Commonwealth Care program.

These and other changes are all explained in detail in the "Roadmap" transition plan. The state will be accepting comments on all the proposals, and will be holding an open meeting on Friday, May 17, at 3 pm at the DPH Public Health Council room (250 Washington St, 2d floor) to discuss ACA implementation.

In our quick preliminary read, we don't see anything particularly new or controversial in these plans. State officials have been very open with advocates and other stakeholders about the plans for ACA implementation. For the public however, the drumbeat of national opposition cannot but raise anxiety. Even though we've gone through this before, a targeted public education campaign will be required. For example, the 200,000 some people transferring from Commonwealth Care will need to be guided through the steps required to switch their coverage. All together, around 560,000 people will see some change in their coverage. The reassurances necessary require the availability of one-on-one assistance to affected people.
-Brian Rosman