Today, Secretary Bigby convened the fifth in a series of stakeholder meetings to discuss Affordable Care Act (ACA) implementation in Massachusetts (see slides from today’s meeting).
One of the big ACA decisions facing state policymakers is what subsidized insurance coverage will look like in 2014. The EOHHS subsidized insurance workgroup established a set of principles to guide their work, and have a keen focus on simplicity and continuity of coverage. While the Massachusetts subsidized coverage framework will look a lot different in 2014, there are several populations whose program eligibility will not change – among them children, dual eligibles, and persons with disabilities. EOHHS explored several options for the populations that will transition to new coverage.
After thorough analysis, the EOHHS subsidized insurance workgroup has narrowed their options to either establish a Basic Health Program or go with the “baseline” Affordable Care Act framework.
The Basic Health Program is an option within the ACA that allows states to cover residents who earn 139-200% of the federal poverty level [fpl] (or 0-200% fpl for “special status” legal immigrants). The state would receive 95% of the premium and cost-sharing credits BHP-eligible individuals would have gotten if they purchased coverage through the Exchange. The BHP must provide at least the yet-to-be defined Essential Health Benefits (EHBs) package (federal officials released a bulletin (pdf) on Friday, giving states broad flexibility in determining EHBs).
The Basic Health Program has the potential to reduce cost sharing for consumers who would otherwise purchase coverage through the Exchange, but questions remain around benefits, cost-sharing, state cost, and how the plan will be administered. Manatt/Mercer – the consulting agency the state hired to analyze subsidized insurance options – will provide further evaluation on some of these questions. We expect EOHHS to share their findings in January. The ACT!! Coalition will be looking closely at the findings, and making recommendations for the best way to protect current members and maximize affordable coverage. The issue will eventually go to the legislature, possibly this summer, or more likely early next year.