Yesterday, the Connector Board met to vote on the FY2013 Commonwealth Care MCO procurement and discuss the proposed subsidized coverage framework for Affordable Care Act implementation. In between these two agenda items, Governor Patrick stopped by to celebrate the sixth anniversary of Massachusetts health reform with the agency responsible for implementing major parts of Chapter 58.
Materials from the meeting are here. Our full report is after the break.
Commonwealth Care FY2013 Procurement Results
Jean Yang, the Connector’s CFO, reviewed results of the FY2013 CommCare procurement. For the second year in a row the Connector was able to save costs in the Commonwealth Care program, which is needed to accommodate expected increased enrollment without cutting benefits or increasing copays.
The aggressive FY13 CommCare procurement resulted in:
- 5% aggregate capitation rate decrease relative to FY12 (which had a 5% decrease from FY11).
- Majority of plans proposed a rate cut for FY13, and every plan now has rates lower than those from FY11.
- No cuts in benefits, no increases in copays.
- All MCOs proposed either the same or expanded networks as compared with FY12.
- Existing members will have the full choice of health plans during open enrollment, and there will be no active open enrollment for FY13.
- All incoming members will have the choice of at least two health plans.
- As with FY12, new Plan Type I members will have the choice of the two lowest cost plans, which are now BMCHP and Network Health (except in select service areas).
BMC HealthNet Plan (BMCHP) and Network Health came in as the two lowest bidders, at $346.30 pmpm and $354.47 pmpm respectively. This was a surprise, as in the current fiscal year (FY12), BMCHP was the highest cost plan. According to the Connector, a key driver of MCOs’ overall cost reduction is unit cost achieved through contract renegotiations with providers and utilization management.
In line with the 2012 Affordability Schedule, the Connector has increased base enrollee premiums for Plan Type II and III members by $1-$2. Overall, however, based on current membership distribution, average FY13 enrollee premiums will decrease relative to FY12. The Board voted to approve the FY2013 CommCare procurement results.
CommCare Open Enrollment Operational Plan
Stephanie Chrobak, Director of Program Management, reviewed the Connector’s operational plan for FY13 open enrollment, which is from June 1-22, 2012. The Connector plans to communicate with members through open enrollment reminder letters; email blasts; and updated website information. Members will also receive customized open enrollment packets.
The Connector also plans to enhance their call center support through increasing staffing levels and improving call center training. In addition, they will engage stakeholders through Mass Health Care Training Forums, advocates meetings, and conference calls with hospitals, health centers, and MCOs.
National Health Reform Update
Ashley Hague, Chief of Staff and Assistant General Counsel, provided the Board with an update on the interagency Subsidized Coverage Workgroup’s plans for ACA implementation. She started out with a review of existing coverage options created through Chapter 58 and options for “tomorrow,” created through the Affordable Care Act (ACA).
The ACA expands eligibility for MassHealth to people at or below 133% fpl and eliminates categorical eligibility. The law also provides tax credits and cost-sharing subsidies for residents up to 400% fpl. However, these subsidies are not as generous as those currently provided in CommCare. In addition, the ACA gives state the option to implement a Basic Health Program for residents 133-200% fpl (0-200% fpl for special status immigrants).
The interagency Subsidized Insurance Workgroup recommends that Massachusetts adopt a Basic Health Program to be administered by MassHeatlh. The group also recommends wrapping federal subsidies to help keep coverage affordable for individuals from 200-300% fpl shopping in the Exchange. Overall, the workgroup is taking a “hold harmless” approach with current enrollees in subsidized insurance programs.
Here are some key benefits of the proposed model, as presented by the Connector:
- Simplicity of collapsing a number of different subsidized programs together.
- Reduced member churn, particularly for childless adults below 133% fpl.
- Real-time eligibility determination.
- Enhanced federal reimbursement and freed-up state dollars.
In addition, these recommendations have implications for what the Connector will look like in 2014. With Medicaid expansion and implementation of a BHP, the Connector’s focus will move to the commercial small and non-group market. “Connector 2.0” hopes to leverage its power to better serve small businesses, upgrade consumer shopping experience, and reinforce payment and delivery system reform.
The next Connector Board meeting is scheduled for Thursday, May 10th from 9:00-11:00 at One Ashburton Place, 21st floor, Boston.