A Healthy Blog

Massachusetts health care — wonky, with a healthy dose of reality

Smoother Sailing for 2016 Open Enrollment

Smoother Sailing for 2016 Open Enrollment

December 11, 2015

Yesterday, the Health Connector Board met to discuss two topics: 2016 open enrollment and transitioning to the federal risk adjustment program. Materials from the meeting are posted here: https://www.mahealthconnector.org/about/leadership/board-meetings.

Over 180,000 enrolled, halfway through open enrollment window

2016 Open Enrollment Update

Half-way through open enrollment for 2016 health coverage, which runs from November 1, 2015-January 31, 2016, more than 180,000 individuals are enrolled in a qualified health plan (QHP) through the Health Connector for January 1, 2016 – inclusive of ConnectorCare, QHP with Advanced Premium Tax Credits (APTCs) and unsubsidized coverage.

One of the reasons Open Enrollment is going more smoothly this year is that the Health Connector is conducting auto-renewals. While members enrolled in Health Connector coverage in 2015 can switch plans at any time during Open Enrollment, members who did not actively choose a plan in November were automatically enrolled into a plan for 2016. Put simply, if a Health Connector member likes their plan, they do not need to do anything – except pay the updated premium – to keep that plan in 2016.

According to the Health Connector, customer service performance has greatly improved from the last Open Enrollment period, and the launch of additional walk-in centers throughout the state and the ombudsman services provide consumers with additional ways to get help with the eligibility and enrollment process.

Risk Adjustment Update

The Affordable Care Act (ACA) requires implementation of a Risk Adjustment (RA) program, which provides payments to health insurance carriers with plans that have higher-than-average risk (i.e., members with more health care needs) funded by transfer payments from health insurance carriers with plans that have lower-than-average risk. Both federal and state methodologies for RA result in significant transfers of money among carriers, as some will have to pay and others will receive payments.

Massachusetts is the only state to run its own RA program, administered by the Health Connector, in collaboration with other state agencies. The federal Centers for Medicare and Medicaid Services (CMS) runs the RA program for every other state. The Commonwealth’s authorization from CMS to operate a state-based RA program runs out at the end of 2017. Health Connector staff proposed that Massachusetts transfer over the RA program to the federal government after the state-based program ends.

Various factors played into this recommendation, including the requirement for a federal extension of authorization to operate the state-based program, federal approval of the payment methodology (which currently very closely follows the federal methodology and would need to be replicable in other states), and higher costs. The RA program is funded through an assessment on carriers, which is twice as expensive as the federal rate for the state-based program, the cost of which is ultimately passed on to consumers. Thus, the Health Connector is not planning  to pursue federal authorization to operate the state-based RA program for the 2017 benefit year and beyond. However, upon urging from Secretary Marylou Sudders and a few Connector Board members, the Health Connector will notify CMS that they may explore re-establishing a state-based program in the future.

The next Connector Board meeting is scheduled for Thursday, January 14th at 2:00pm at 1 Ashburton Place, 21st floor, Boston.

               -- Suzanne Curry