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Life with The Connector

Life with The Connector. Massachusetts Health Insurance Exchange Deborah C. Enos President and CEO, Neighborhood Health Plan ACAP CEO Summit | July 13, 2010. Recap of Massachusetts Health Care Reform (2006). Medicaid Expansion Commonwealth Care (subsidized)

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Life with The Connector

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  1. Life with The Connector Massachusetts Health Insurance Exchange Deborah C. Enos President and CEO, Neighborhood Health Plan ACAP CEO Summit | July 13, 2010

  2. Recap of Massachusetts Health Care Reform (2006) • Medicaid Expansion • Commonwealth Care (subsidized) • Commonwealth Choice (commercial) • Individual Mandate • Employer Responsibilities • Insurance Reforms

  3. What is the Connector? An Independent State Agency • Connector Board • Executive & AdministrativeStaff

  4. What is the Connector? The Board: 10 Members • 4 Ex Officio • Secretary A & F • Medicaid Director • 1 Actuary • 1 Economist • 1 Health Policy • 3 Employer/Labor • Commissioner of Insurance • Executive DirectorGroup Insurance Commission Administration: Executive Director & Staff

  5. Connector Board • “Open/Closed” Meetings • Schedule • Interaction with Plans • Sub-committees • Policy • Outreach

  6. What does the Connector do? • Makes Policy Decisions (per Ch. 58) • Conducts Outreach/Advertising • Operates Two Exchanges • Commonwealth Care • Commonwealth Choice

  7. Policy Decisions • Minimum Creditable Coverage • Plan Design (Benefits & Premiums) • Affordability Standards • Mandate Waivers • MCO Approval (“Seal of Approval”) • Insurance Risk Oversight • Distribution Channels

  8. Advertising and Outreach • Public Campaign (Red Sox) • Website: MAHealthConnector.org • Community Grants • Health Plans

  9. The Connector: “Two Exchanges in One” Commonwealth Care5 MCOs Subsidized Commonwealth Choice7 MCOs Commercial, Non-Group, Small-Group (Standard Benefits; Administration) “Medicaid”- Like (Standard Benefits; Administration) “Intermediary”- Like Eligibility Enrollment Premium Billing Customer Service Appeals

  10. Exchange Design Considerations • Active vs. Passive Role • Medicaid vs. Commercial Framework • Governance Authority • Experience of Leadership • Involvement of Stakeholders • Transparency • Evaluation & Monitoring

  11. Thank you

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