A Healthy Blog

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

Connector Board Reviews 2016 Open Enrollment, Looks Towards Waiver Application

Connector Board Reviews 2016 Open Enrollment, Looks Towards Waiver Application

January 19, 2016

Last week, the Connector Board met to share progress during open enrollment, discuss proposed policies for a federal State Innovation waiver, and voted on a restructured contract with customer service and billing vendor Dell. Materials from the meeting can be found here.

In addition, the Board bid a fond farewell to Dolores Mitchell, who is retiring after nearly 30 years leading the Group Insurance Commission (GIC), the agency that provides health and other benefits to state and certain municipal employees. Dolores has served on the Connector Board since its inception, and for much of the time has been the Board’s Vice Chair. Thank you, Dolores for your important leadership in health policy formulation and implementation in Massachusetts!

Open Enrollment & Outreach Update

Open Enrollment update 1-14-16

The 2016 Open Enrollment period – November 1, 2015-January 31, 2016 – is going much more smoothly than the past several years. For one, IT systems improvements have made applying and shopping for coverage simpler. Second, Health Connector members enrolled in a plan in 2015 do not have to actively re-enroll if they want to keep their plan – they just need to keep paying their premium. However, they do have the option to switch plans at any point during the open enrollment period.

There are about 189,000 members enrolled in 2016 coverage (January or February start date) through the Health Connector. The retention rate for renewing members is about 92%; the vast majority of whom stay within the same metallic tier as in 2015. Nearly 28,000 of the 189,000 enrollees are new. “New” means that the members were not enrolled in MassHealth in 2015 nor enrolled in the Health Connector through the newer IT system (hCentive) in the past year. Of all new members, 88% reported being previously insured while 12% reported never having had insurance before. According to the Health Connector, preliminary data suggest that their and Navigators’ targeted outreach efforts are prompting the uninsured to sign up for coverage, particularly in the top 10 communities with the highest numbers of uninsured.

Last week, the Health Connector sent a communication to members enrolled in Bronze plans reminding them to review their benefits and that they still have time to switch plans. 1095 tax forms will be sent to Health Connector enrollees who received advanced premium tax credits (APTCs) in 2015; they have already let these members know to wait until they receive this form to file their taxes. In addition, the Health Connector is sending emails, preparing press releases, and supporting Navigator events to educate the public about the January 31st open enrollment deadline, as well as preparing call and walk-in centers for the increased volume towards the end of the month.

In addition, the Health Connector is outreaching to potential members about the possibility of enrolling in health insurance outside the open enrollment period should they encounter life changes, or “qualifying events.” The Health Connector is working with the Division of Unemployment Assistance (DUA) on a mailing to educate employers about Health Connector coverage as an alternative to COBRA for employees leaving their jobs, as well as options for non-benefit eligible employees.

EOHHS Secretary and Board Chair Marylou Sudders asked whether there had been a cost-benefit analysis of the Connector’s outreach efforts, as the rate of uninsurance in Massachusetts has held relatively steady at 3-4% since passage of health reform in 2006. She expressed concern about the sustainability of the state’s programs, including Connector and MassHealth, and the need to discuss cost. Connector Deputy Executive Director Ashley Hague responded that while the uninsurance rate has remained relatively stable, it’s not likely the same people who are included in that rate over time. There is a lot of fluctuation in health insurance coverage as people experience life changes. Audrey Gasteier, the Connector’s Director of Policy and Outreach, added that they are looking at Department of Revenue (DOR) data to determine how many of the 3-4% of uninsured are the same people and whether most uninsured are experiencing gaps in coverage rather than chronic uninsurance.

State Innovation Waiver Update

Basic requirements for a federal 1332 waiver

Section 1332 of the Affordable Care Act (ACA) gives states the option of waiving certain provisions of the ACA. The Health Connector has led a robust stakeholder process to help inform their policy direction for the State Innovation Waiver opportunity, and has a web page dedicated to the topic. After receiving input from various stakeholders, the Health Connector has proposed a two-phase process. For Phase 1, the Commonwealth will seek an application with the federal government to allow Massachusetts to continue rolling enrollment and quarterly rating in the small group market. Under a separate provision of the ACA, Massachusetts was able to keep these features of the small group market until 2018. If accepted, the 1332 waiver would allow Massachusetts to permanently maintain these provisions.

The Health Connector plans to make the draft waiver application available to the public this month, with public hearing scheduled on February 5th in Boston and February 19th in Springfield, and anticipated submission to the federal government in March.

The Health Connector will continue exploring additional policy issues raised by stakeholders for a potential Phase 2 application, including the impact of federal actuarial value calculator on plan design and the scope of eligibility gaps that prevent some lower-income residents from accessing subsidies.

The next Connector Board meeting is scheduled for Thursday, February 11th at 9:00am, One Ashburton Place, 21st floor, Boston.

      -- Suzanne Curry