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Affordable Care Act Implementation Update

Learn about the benefits of the Affordable Care Act in Massachusetts and how it will affect residents. Find out what changes to expect in coverage and what actions need to be taken. Discover how the Health Connector can help individuals take advantage of ACA benefits.

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Affordable Care Act Implementation Update

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  1. Affordable Care Act Implementation Update Executive Office of Health & Human Services (MassHealth) Commonwealth Health Insurance Connector Authority (Health Connector) October 10, 2013

  2. Agenda What is the Affordable Care Act and how it will help Massachusetts residents? How is people’s coverage changing, and what do they need to do? What will applicants through the Health Connector see beginning October? How to help people take advantage of the benefits of the ACA

  3. Key Messages • The Affordable Care Act (ACA) brings enormous benefits to the Commonwealth and supports the Patrick Administration’s commitment to making affordable, high-quality health care accessible to all residents • The ACA also offers Massachusetts the unique opportunity to revisit its online health insurance Marketplace, the Health Connector, to modernize Medicaid and bring eligibility determination for subsidized health insurance online and in real time

  4. Key features of the ACA • Expands Medicaid (up to 133% FPL), at state option • Creates affordable insurance coverage options for low and middle income families with incomes up to 400% FPL • Establishes federal tax credits for small businesses • Creates health insurance Exchanges, marketplaces where individuals, families and small businesses can purchase affordable, high-quality insurance • Implements insurance market reforms and new consumer protections • Requires all adults to get health insurance for themselves and their children, if it is affordable

  5. ACA strengthens state finances • Enhances federal assistance for coverage that the Commonwealth has already been providing • 75%-100% federal matching for Medicaid expansion population in 2014-2019, then 90% federal matching starting in 2020 • Federal subsidies for legal immigrants – currently covered at 100% state cost The changes are expected to bring in $2 billion in incremental federal support between 2014 and 2019, and over $500 million in each year thereafter In addition, Massachusetts has received a number of one-time grants, including over $270 million to support ACA implementation and 23 grants to DPH

  6. ACA protects consumers and promotes market competition • Builds upon Massachusetts’ reform of the insurance market • Free preventive care • Prohibits pre-existing condition exclusions and waiting periods • Risk mitigation programs discourage “cherry-picking”, stabilize premiums and promote long-term competition • Makes comparison shopping for small employers and individuals easier by grouping health insurance products by metallic tier (originally introduced by the Health Connector)

  7. ACA supports innovation and long-term sustainability in health care • Supports payment and delivery system reform, such as through the duals initiative, accountable care organizations (ACOs), and the State Innovation Model grants • MassHealth’s “One Care” Duals Demonstration begins enrollment in October 2013 • Massachusetts has 5 Pioneer ACOs and 12 Medicare Shared Savings ACOs • Massachusetts received a $44M State Innovation Model grant • Invests in primary care, such as by enhancing payments to primary care providers in Medicaid and Medicare • Extends the solvency of the Medicare trust fund by 12 years

  8. ACA streamlines state health programs • Substantially simplifies a “patchwork” of subsidized programs, making them easier to navigate and more efficient to administer • Several programs will end, but everyone in those programs will qualify for similar or better benefits in 2014 • New Health Insurance Exchange-Integrated Eligibility System (HIX-IES) will allow for easy program determination

  9. ACA preserves and expands access to affordable health insurance • Expands Medicaid to 133% of the Federal Poverty Level (FPL) • Streamlines programs for current MassHealth members and opens up eligibility to new populations • Provides premium tax credits for individuals from 133-400% FPL (lawfully present immigrants 0-400% FPL) through the Connector • Currently, Commonwealth Care goes up to 300% FPL only • The Health Connector will provide a state “wrap” to 0-300% FPL members to preserve current affordability through a set of ACA-compliant qualified health plans called “ConnectorCare Plans” Health Connector 400% Tax Credits 300% ConnectorCare MassHealth 133% Medicaid Expansion (Care Plus) ConnectorCare(AWSS Only) 0% 2013 Federal Poverty Guidelines *For bigger households or more information, go to aspe.hhs.gov/poverty, MAhealthconnector.org or HealthCare.gov

  10. What do people in Massachusetts need to do? • Most residents in Massachusetts do not have to do anything new to comply with the ACA, as most of our residents are already insured (97% of adults, nearly 100% of children) • Most MassHealth members will also do not have to do anything, even if their coverage is changing because of the ACA • Most Health Connector members WILL have to do something – that is because the Health Connector is changing to become an ACA-compliant Marketplace and members staying with the Health Connector in 2014 will have to re-apply for their coverage • Members who need to reapply can do so during Federal Open Enrollment, October 1, 2013-March 31, 2014 • To avoid a gap in coverage, most people who need to should reapply by December 23rd, 2013

  11. Key changes at MassHealth 2014 MassHealth Programs • Changes to MassHealth coverage go into effect on January 1, 2014 • All adults who are U.S. citizens and qualified aliens earning 133% FPL or less will qualify for MassHealth – most for the new CarePlus program • 19 and 20 year olds earning 150% FPL or less will qualify for MassHealth Standard • All pregnant women earning 200% FPL or less will qualify for MassHealth Standard • Individuals seeking MassHealth coverage should continue to apply through current paper process or the Virtual Gateway (with help from a provider) during October to mid-December 2013 for immediate benefits

  12. MassHealth member transition process • MassHealth current members or new MassHealth applicants (cont’d) • Certain members’ coverage is changing due to the Medicaid expansion: • MassHealth Basic • MassHealth Essential • Insurance Partnership • Commonwealth Care and Health Safety Net under 133% FPL • 19 and 20 year olds under 150% FPL • These members do not need to reapply – they will be automatically enrolled in their new coverage for January 1 • Only Medical Security Program (MSP) members will need to apply to find out if they qualify for MassHealth • All members will have an opportunity to choose a new health plan • If they do not choose a health plan, they will be auto-enrolled into a plan in their area

  13. Key changes at the Health Connector 2014 Health Connector Programs • Health Connector current members or new Health Connector Applicants • Most changes to Health Connector coverage go into effect on January 1, 2014 and open enrollment starts October 2013 • Individuals seeking Health Connector coverage before January 1, 2014 should continue to apply through current processes

  14. Who should reapply for Health Connector coverage? • Health Connector current members or new Health Connector Applicants • Most Health Connector members need to re-apply for coverage during the federal open enrollment period (October 1, 2013-March 31, 2014) • Health Connector members that become newly eligible for MassHealth (non-AWSS below 133% FPL) need not re-apply, and will automatically be transferred to MassHealth prior to January 1, 2014 • Current Commonwealth Care members that will not move to MassHealth should reapply by December 23, 2013 to avoid a gap in coverage • The Commonwealth Care program is set to close on December 31, 2013 • Current Commonwealth Choice and Young Adult Plan members need to reapply before the end of their current health coverage to avoid a gap • Most Commonwealth Choice members have coverage through the end of March 2014 • YAP members’ coverage ends December 2013

  15. Who should reapply for Health Connector coverage? (cont.) • Other populations that should apply or reapply during open enrollment (October 2013-March 2014) • Uninsured individuals receiving services through the Health Safety Net who earn greater than 133% FPL or that are lawfully present aliens at any income (to see if they qualify for coverage under new rules) • Certain Insurance Partnership employees earning greater than 133% FPL who may be newly eligible for assistance through the Health Connector (that program ends December 31, 2013) • Children’s Medical Security Plan members (to ensure that they have ACA-compliant coverage) • All Medical Security Program members (that program ends December 31, 2013) • The Health Connector and MassHealth will also be calling all members that need to reapply and will be sending letters and other materials to members that need to do something during open enrollment

  16. What is the new HIX-IES system? • The Health Connector, in partnership with the Executive Office for Health and Human Services and UMass Medical School, have been working to develop a highly customized, integrated eligibility determination and shopping system to serve Health Connector and MassHealth members

  17. What will applicants through the Health Connector see beginning October 1? • Beginning October 1, anyone who wishes to apply for help paying their premiums can submit an application online for the first time! • Applicants who are not seeking help to pay for their health insurance may shop for a new health or dental plan • Later this fall, we will phase in real-time eligibility determination, plan selection and enrollment so that the entire process can take place on-line • Over the next few months, additional enhancements will be integrated into the new system: • Automated dental services will come on-line for individuals • MassHealth eligibility, shopping and enrollment will be fully integrated • New portals will be created for outreach workers • Additional decision-support features will be added, like an out-of-pocket cost calculator and live chat functionality with customer service representatives

  18. Where people can go for help • Keep them informed! Send them to MAhealthconnector.org to sign up for email updates or to begin their application process, or direct them to places that can help them apply • Navigators (full list in Appendix) • Certified Application Counselors (list of current “CACs” in Appendix) • Brokers (check out http://agentfinder.doi.state.ma.us/) • Health Care For All HelpLine (1-800-272-4232) • Health Connector Customer Service (1-877 MA ENROLL (1-877-623-6765) or TTY 1-877-623-7773) • General Health Connector and MassHealth HelpLine (1-855-MA-4-HLTH (1-855-624-4584), TTY 1-877-623-7773) • If you have questions about the ACA or the new system, contact the Health Connector’s Public Information Unit for information by selecting the appropriate prompt on the Health Connector’s Customer Service line

  19. Questions?

  20. Appendix – List of Navigators Boston Public Health Commission1010  Massachusetts AvenueBoston, MA 02118 Phone: 800-847-0710 or 617-534-5050Website:bphc.org/programs/cib/civicengagement/mhl/Pages/Home.aspx Region(s) covered: City of Boston Caring Health Center1145 Main Street, Suite 205Springfield, MA 01103 Phone: 413-693-1002Website:caringhealth.org Region(s) covered: Springfield metro area Community Action Committee of Cape Cod & Islands, Inc.372 North StreetHyannis, MA  02601 Phone: 800-845-1999 or 508-771-1727Website:cacci.cc Region(s) covered: Cape Cod, Martha’s Vineyard, Nantucket, Cuttyhunk Island Ecu-Health Care71 Hospital AvenueNorth Adams, MA 01247 Phone:413-663-8711Website:ecuhealth.boxcarexpress.com Region(s) covered: Northern Berkshire County Greater Lawrence Community Action Council305 Essex StreetLawrence, MA 01840 Phone: 978-681-4905Website:glcac.org Region(s) covered: Lawrence, Methuen, Andover, North Andover HilltownCommunity Health Care Centers58 Old North RoadWorthington, MA 01098 Phone: 413-238-5511Website:hchcweb.org Region(s) covered: The Hilltowns of western MA (11 towns in Hampshire and Hampden counties) Joint Committee for Children’s Health Care in Everett484 Broadway, Room 27Everett, MA 02149 Phone: 617-394-2414 or 617-394-0606Website:jcchce.org Region(s) covered: Everett, Chelsea, East Boston, Malden, Revere, Somerville ManetCommunity Health Center110 West Squantum StreetNorth Quincy, MA 02171 Phone: 617-376-3000Website:manetchc.org Region(s) covered: South Shore – incl. Quincy, Weymouth, Braintree, Canton, Milton MAPS – MA  Alliance of Portuguese Speakers1046 Cambridge StreetCambridge, MA 02139 Phone: 617-864-7600Website:maps-inc.org Region(s) covered: Cambridge, Somerville, Everett, Lowell, Lawrence, Framingham, Hudson, Milford, Brockton, Stoughton, Quincy, New Bedford, Fall River, Taunton PACE – People Acting in Community Endeavors166 William StreetNew Bedford, MA 02740 Phone: 508-999-9920Website:paceinfo.org Region(s) covered: Greater New Bedford – incl. New Bedford, Fairhaven, Dartmouth, Acushnet, Rochester, Mattapoisett, and Marion

  21. Appendix – List of Certified Application Counselors (as of September 2013) Boston Beth Israel Deaconess Medical Center330 Brookline AvenueBoston, MA 02492Website:www.bidmc.harvard.edu Boston Children’s Hospital300 Longwood AvenueBoston, MA 02115Website:www.childrens.harvard.edu Boston Health Care for the Homeless780 Albany StreetBoston , MA 02118Website:www.bhchp.org Boston Medical CenterOne Boston Medical Center PlaceBoston, MA 02118Website:www.bmc.org Community Care Alliance330 Brookline Avenue BR-270Boston, MA 02215Website:www.bidmc.harvard.edu Healthcare Financial200 High Street, 6th FloorBoston, MA 02110Website:www.hfihealthcare.com Massachusetts General Hospital55 Fruit StreetBoston, MA 02114Website:www.partners.org North End Community Health Committee Inc.North End Watherfront Health332 Hanover StreetBoston, MA 02113Website:www.partners.org South Cove Community Health Center885 Washington StreetBoston, MA 02111Website:www.scchc.org Southern Jamaica Plain Health Center75 Francis StreetBoston, MA 02115Website:www.partners.org Tufts Medical Center800 Washington StreetBoston, MA 02111Website:www.tuftsmedicalcenter.org Allston Joseph M Smith Community Health Center287 Western AvenueAllston, MA 02134Website:www.jmschc.org Athol Athol Memorial Hospital2033 Main StreetAthol, MA 01331Website:www.heywood.org Attleboro Sturdy Memorial Hospital211 Park StreetAttleboro, MA 02703Website:www.sturdymemorial.org Beverly Northeast Hospital Corporation(Beverly Hospital, Bay Ridge Hospital & Addison Gilbert Hospital)85 Herrick StreetBeverly, MA 01915Website:www.nhs-healthlink.org

  22. Appendix – List of Certified Application Counselors (as of September 2013) (cont’d) Partners Healthcare System Inc.Schraft Center529 Main StreetCharlestown , MA 02129Website:www.partners.org Chelsea MGH Chelsea Healthcare Center151 Everett AvenueChelsea, MA 02150Website:www.partners.org Dorchester Bowdoin Street Health Center230 Bowdoin StreetDorchester, MA 02122Website:www.bidmc.harvard.edu Codman Square Health Center637 Washington StreetDorchester, MA 02124Website:www.codman.org Dorchester House Multi-Service Center1353 Dorchester AvenueDorchester, MA 02122Website:www.dorchesterhouse.org Harbor Health Services Inc.Geiger Gibson Community Health Center250 My Vernon StreetDorchester, MA 02125Website:www.hhsi.us Harbor Health Services Inc.Neponset Health Center398 Neponset AvenueDorchester, MA 02122Website:www.hhsi.us Harvard Street Neighborhood Health632 Blue Hill AvenueDorchester, MA 02121Website:www.harvardstreet.org Upham’s Corner Health Committee, Inc.500 Columbia RoadDorchester, MA 02125Website:www.uphams.org East Boston East Boston Neighborhood Health Center10 Grove Street EastBoston, MA 02128Website:www.ebnhc.org Brockton Brockton Neighborhood Health Center63 Main StreetBrockton, MA 02301Website:www.bnhc.org Signature Healthcare Brockton Hospital680 Centre StreetBrockton, MA 02302Website:www.signature-healthcare.org Burlington Fishing Partnership Support Services30 Chestnut Avenue, Suite #2Burlington , MA 01803Website:www.fishingpartnership.org Cambridge Mount Auburn Hospital330 Mount Auburn StreetCambridge, MA 02138Website:www.mah.harvard.edu Charlestown MGH Charlestown Healthcare Center73 High StreetCharlestown , MA 02129Website:www.partners.org

  23. Appendix – List of Certified Application Counselors (as of September 2013) (cont’d) Fairview Hospital29 Lewis AvenueGreat Barrington, MA 01230Website:www.bhs1.org Greenfield Community Health Center of Franklin County489 Bernardston RoadGreenfield, MA 01301Website:www.chcfc.org Holyoke Holyoke Health Center230 Maple StreetPO Box 6260Holyoke , MA 01041Website:www.hhcinc.org Holyoke Medical Center Inc.575 Beech StreetHolyoke , MA 01040Website:www.holyokehealth.com Hyannis Cape Cod Healthcare25 Communication WayHyannis, MA 02601Website:www.capecodehealth.org Duffy Health Center94 Main StreetHyannis, MA 02601Website:www.duffyhealthcenter.org Harbor Community Health Center – HyannisEllen Jones Community Dental Center30 Elm AvenueHyannis, MA 02601Website:www.hhsi.us Jamaica Plain Brookside Community Health Center3297 Washington StreetJamaica Plain, MA 02130Website:www.partners.org Southern Jamaica Plain Health Center (licensed by Brigham and Women’s Hospital)640 Centre StreetJamaica Plain, MA 02130Website:www.partners.org Lawrence Lawrence General Hospital1 General StreetPO Box 189Lawrence, MA 01842Website:www.lawrencegeneral.org Fall River Healthfirst Family Care Center387 Quarry Street, Suite 100Fall River, MA 02723Website:www.healthfirstfr.org Stanley Street Treatment & Resources Inc.(Family Healthcare Center)386 Stanley StreetFall River, MA 02720Website:www.sstar.org Framingham MetroWest Medical Center115 Lincoln StreetFramingham, MA 01702Website:www.vhsnewengland.com Gardner Heywood Memorial Hospital242 Green StreetGardner, MA 01440Website:www.heywood.org Great Barrington Community Health Programs444 Stockbridge RoadPO Box 30Great Barrington, MA 01230Website:www.chpberkshires.org

  24. Appendix – List of Certified Application Counselors (as of September 2013) (cont’d) Mattapan Mattapan Community Health Center1575 Blue Hill AvenueMattapan, MA 02126Website:www.matchc.org Medford Cambridge Health Alliance101 Station LandingMedford, MA 02155Website:www.challiance.org Hallmark Health Systems Inc.170 Governors AvenueMedford, MA 02155Website:www.hallmarkhealth.org Methuen Greater Lawrence Family Health CenterOne Griffin Brook Drive, Suite 101Methuen, MA 01844Website:www.glfhc.org Milford Milford Regional Medical Center14 Prospect StreetMilford, MA 01757Website:www.milreg.org Needham Beth Israel Deaconess Needham Hospital148 Chestnut StreetNeedham, MA 02492Website:www.bidneedham.org New Bedford Greater New Bedford Community Health Center874 Purchase StreetNew Bedford, MA 02740Website:www.gnbchc.org SouthcoastHospitals Group101 Page StreetNew Bedford, MA 02740Website:www.southcoast.org Newburyport Anna Jaques Hospital25 Highland AvenueNewburyport, MA 01950Website:www.ajh.org Pittsfield Berkshire Medical CenterBerkshire Health Systems510 North StreetPittsfield, MA 01201Website:www.bhs1.org Lowell Lowell Community Health Center161 Jackson StreetLowell, MA 01852Website:www.lchealth.org Lowell General Hospital295 Varnum AvenueLowell, MA 01854Website:www.lowellgeneral.org Lynn Lynn Community Health Center269 Union StreetLynn, MA 01901Website:www.lchcnet.org Marlborough Marlborough Hospital157 Union StreetMarlborough, MA 01751Website:www.umassmemorial.org Mashpee Community Health Center of Cape Cod107 Commercial StreetMashpee, MA 02649Website:www.chcofcapecod.org

  25. Appendix – List of Certified Application Counselors (as of September 2013) (cont’d) Salem North Shore Community Health, Inc..27 Congress StreetSalem, MA 01970Website:www.nshi.org North Shore Medical Center (Partners HC)81 Highland AvenueSalem, MA 01970Website:www.partners.org South Boston South Boston Community Health Center409 W Broadway SouthBoston, MA 02127Website:www.sbchc.org Southbridge Harrington Hospital100 South StreetSouthbridge, MA 01550Website:www.harringtonhospital.org Springfield Baystate Health759 Chestnut StreetSpringfield , MA 01199Website:www.baystatehealth.org Caring Health Care1145 Main StreetSpringfield , MA 01103Website:www.caringhealth.org Wellfleet Outer Cape Health ServicesPO Box 1413Wellfleet, MA 02667Website:www.outercape.org West Tisbury Island Health Inc.PO Box 1619West Tisbury, MAWebsite:www.vineyard.net Westfield Noble Hospital115 West Silver StreetWestfield, MA 01085Website:www.noblehealth.org Weymouth South Shore Hospital55 Fogg StreetWeymouth , MA 02190Website:www.sshosp.org Plymouth Jordon Hospital275 Sandwich StreetPlymouth, MA 02360Website:www.jordanhospital.org Quincy Manet Community Health Center110 W Squantum StreetQuincy, MA 02171Website:www.manetchc.org Roslindale Boston Medical Center d/b/aGreater Roslindale Medical & Dental Center4199 Washington StreetRoslindale, MA 02131Website:www.bmc.org Roxbury The Dimock Center55 Dimock StreetRoxbury, MA 02119Website:www.dimock.org Whittier Street Health Center1290 Tremont StreetRoxbury, MA 02120Website:www.wshc.org

  26. Appendix – List of Certified Application Counselors (as of September 2013) (cont’d) Worcester Community Healthlink72 Jaques AvenueWorcester, MA 01610Website:www.communityhealthlink.org Edward M Kennedy Community Health Center2000 Century DriveWorcester, MA 01606Website:www.kennedychc.org Family Health Center of Worcester26 Queens StreetWorcester, MA 01604Website:www.umassmed.edu Saint Vincent Hospital123 Summer StreetWorcester, MA 01608Website:www.vhsnewengland.com UMass Memorial Medical Center1 Biotech365 Plantation StreetWorcester, MA 01605Website:www.umassmemorial.org Check out MAhealthconnector.org for updates to this list

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