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The Receding Shor - Connector Board Report 12/11/14

The Receding Shor - Connector Board Report 12/11/14

December 14, 2014

Last Thursday’s Connector Board meeting began with a bittersweet farewell to outgoing Administration & Finance Secretary Glen Shor, who has been a leader in Massachusetts health reform implementation since 2007, holding multiple roles in Administration & Finance as well as Executive Director of the Health Connector, preceding Jean Yang.

Shor gave a moving goodbye speech, and recognized Jean Yang’s leadership of the Health Connector, particularly during the most recent difficult times; Yang received a standing ovation from the Board and audience alike.

After the heartfelt overtures, the Connector Board got down to business. With over 150,000 people already determined eligible for coverage for next year, the Connector is pleased with progress. They outlined a number of key improvements planned for next year, and detailed the extensive outreach campaign. We were particularly proud of the numerous shout-outs to Health Care For All from the Connector leadership for our outreach work.

HCFA outreach campaign highlighted by the Connector (12-11-14)

The Connector Board also voted to:

  • Extend a contract with Dell to complete integration with the hCentive eligibility and enrollment system, to ensure back-end functions such as sending financial and enrollment files to health insurance carriers are completed.
  • Extend the Commonwealth Care program through January 31, 2015 to align with the Commonwealth’s coverage transition plans.
  •  Release proposed state-based market-wide risk adjustment regulations, focusing on operational processes, for public comment.

For your reference, all the meeting materials are here, with the two key presentations updating board members on progress with the online enrollment system, and the outreach and education efforts. Our detailed report is on the flip.



Dell Contract Extension

As noted above, the Connector Board gave approval for the Health Connector to enter into additional work orders with Dell, the vendor who has been providing back-end support on financial and enrollment transactions with health insurance carriers. Complete integration with the hCentive system is expected to be completed in the Spring of 2015.

Commonwealth Care Extension

The Connector Board voted to extend the Commonwealth Care program for current enrollees through January 31, 2015. The Commonwealth had already received permission from the federal government to extend the program; the Board vote was necessary to effectuate the extension and make adjustments to the rates provided to the Commonwealth Care Managed Care Organizations (MCOs). The Connector is providing MCOs with a 6% rate increase for the month of January for those Commonwealth Care members who remain in the program (who have not enrolled in the new system for 1/1/2015 coverage).

The Health Connector will also provide Network Health, who administers coverage for the former Medical Security Program (MSP) members who had been rolled into the Commonwealth Care program, with a $10 per member per month increase for members who remain in the program during the month of January.

In addition, a new Health Insurer Provider Fee, established under the Affordable Care Act (ACA), applies to Commonwealth Care MCOs. The fee is calculated based on preceding year expenses. For 2013, the tax applied to four out of five Commonwealth Care MCOs (BMC HealthNet was not subject to the fee). As such, the Connector will provide the affected MCOs with a 2013 base capitation rate adjustment, totaling $4,898,868. The reason for the payout is tied to the Connector’s obligation to provide actuarial sound rates. MassHealth will go through a similar process with its MCOs.

Risk Adjustment Regulations

Effective 2014, the ACA requires implementation of a risk adjustment program for the individual and small-group markets. Massachusetts is the only state who has received approval from the federal government to operate its own, state-based risk adjustment program. The Health Connector administers this program for the entire individual and small group market - for products sold both within and outside the Connector.

Risk adjustment is a multi-step process, including:

  • Data submission & resolving discrepancies
  • Calculating and effectuating payments & charges to insurers
  • Reviewing and providing remediation for reconsideration requests from insurers
  • Data validation

The Health Connector is proposing regulations that focus on the operations and processes for the risk-adjustment program, based on those promulgated by the U.S. Department of Health & Human Services for the federal risk adjustment program.

The risk adjustment regulations are under 956 CMR 13.00. A public hearing is scheduled for January 28, 2015. The Connector Board is expected to vote on final regulations at their February 12th meeting.

Open Enrollment & System Update

Since November 15th, over 150,000 Massachusetts residents have received an eligibility determination for ACA-compliant coverage. About 68,000 have been enrolled in MassHealth and approximately 80,000 have been found eligible for Health Connector programs. The website, which has had over 1 million unique visitors, is functioning and capable of eligibility determinations, shopping and enrollment, and of supporting a large number of concurrent users.

Connector Enrollment system summary 12-11-14

Health Connector and MassHealth customer service are seeing high volumes of calls, the highest usually on Monday mornings; both call centers have had an average of 452 staff on hand every day to serve the high volumes of calls. The Health Connector and MassHealth are also making efforts to address issues right away - for example, issues related to the identify proofing process (required for online applications), coding errors, and multiple notices.

The Administration, with leadership from Maydad Cohen, have made transparency and public engagement a priority during this open enrollment period. They are releasing daily and weekly dashboards with details about enrollment, holding daily press briefings, meeting with health insurers, advocates, and assisters, and providing daily assister email updates.

Beginning December 15th, consumers who have submitted an application and/or enrolled in a plan will be able to make changes to their accounts. (Up until now, once someone hit the “submit” button on their application, the application was locked and very difficult to unlock). To make any account changes, consumers should call Health Connector or MassHealth customer service.

Looking forward, the Commonwealth has created a preliminary roadmap for work and improvements in 2015, including:

  • New Small Business Health Options Program (SHOP) online portal
  • Electronic payment system improvements
  • Simpler guidance for how to enter income and immigration information in the application to better reflect an applicant’s unique circumstances
  • Bring more MassHealth services online in 2015, including online premium billing, case management and notices
  • Streamline how notices and Requests for Information (RFIs) are sent to members and permanently fix the logic causing duplicate notices

The Health Connector and MassHealth are also looking more closely at coverage transitions, To better understand the temporary MassHealth population, MassHealth examined over 40,000 former temporary coverage members. Of those, 90% continue to qualify for subsidies through MassHealth or the Health Connector. About 10% were determined eligible for unsubsidized Qualified Health Plans (QHPs). About 2/3 of temporary MassHealth members used health care services while on temporary coverage.

As for the budget, the Commonwealth previously reported that IT costs for building the new hCentive eligibility and enrollment system cost about $254 million - $80 million more than originally envisioned. The state share of this cost is $42 million.

MassHealth temporary coverage was completely supported in 2014 through the existing MassHealth budget. No additional appropriations were required. For the first few months of Fiscal Year 2015, the state has paid $359.5 million on a gross basis for services provided to temporary MassHealth members. The cost of this coverage will decline as people enroll in their new ACA-compliant coverage.

2015 Open Enrollment Outreach & Education

Since the beginning of open enrollment on November 15th, the Health Connector, MassHealth, and partners in the community (including Health Care For All), have engaged in a comprehensive outreach and education campaign.

Outreach strategies include:

  • Direct member contact: mailings, outbound calls, increased call center staffing
  • Enrollment events: One in Springfield, one in Boston, drew hundreds of residents who could apply for coverage right then and there (staffed by Health Connector, MassHealth staff as well as certified application counselors and navigators from the community). Additional events are scheduled in January in Worcester an Fall River.
  • Community outreach: Community organizations conduct their own efforts; Health Care For All is leading a canvassing campaign to knock on 200,000 doors
  • Media: TV, print, social media, radio, including local and ethnic media outlets

These outreach and education efforts have resulted in a high volume of applications and eligibility determinations.

Here are some more details about enrollments on the Health Connector side:

  • ConnectorCare: 4,121
  • Qualified Health Plans (QHPs) with Advanced Premium Tax Credits (APTCS): 106
  • Unsubsidized QHPs: 2,310

For unsubsidized and APTC-only QHPs, the highest level of enrollment are in Silver-level plans. Neighborhood Health Plan has the highest enrollment within this population, followed by Harvard Pilgrim.

About 55% of ConnectorCare enrollees have chosen Tufts Health Plan - Network Health, the lowest-cost plan in most areas of the state. As far as plan type, 38% are in Plan Type 1 (0-100% of the federal poverty level); 45% in Plan Type 2 and 16% in Plan Type 3.

The Health Connector is particularly concerned about those who are QHP eligible, who must apply, choose a plan and pay their premium by December 23rd to be enrolled in coverage for January 1st (as their current coverage ends on December 31st). These folks will receive a payment reminder postcard to encourage them to act.

The next Connector Board meeting is scheduled for Thursday, January 8, 2015 at 9:00am,  One Ashburton Place, 21st floor, Boston.

     - Suzanne Curry