Massachusetts Health Care Reform and Adult Members with Disabilities

1. Massachusetts Health Care Reform and Adult Members with Disabilities Annette Shea, MEd and Jay Himmelstein MD, MPH University of Massachusetts Medical School Center for Health Policy and Research Disability and Employment Policy Research Group November 9, 2009

2. Agenda • Overview of Massachusetts Health Care Reform • MassHealth and “CommonHealth”: The Massachusetts Medicaid Buy-In program • Health Reform and Medicaid - Lessons learned • Implications for PWD and Medicaid Buy-in programs • Discussion

3. Created “Connector Authority” – Board and Insurance Exchange MassHealth (Medicaid) Expansion - Expansion of financial rules for non-disabled categories New insurance options for legal residents who are not eligible for other public or employer-sponsored health insurance: Completely subsidized, comprehensive health insurance to adults earning up to 150% of the federal poverty level (FPL). Commonwealth Care– subsidized insurance for those less than 300% FPL Commonwealth Choice– offered through Connector Authority, links individuals over 300% of FPL with health insurance Reforms to the commercial market Individual Mandate Employer “fair share” assessment for those with 11+ full-time equivalent employees. Massachusetts Health Care Reform of 2006: Key Elements

4. An independent state agency which helps Massachusetts individuals and employers get more affordable health insurance coverage. Provides low or no-cost health insurance to qualified residents (Commonwealth Care). Works with insurance companies to create new health insurance choices for individuals and employers (Commonwealth Choice). The Connector Board also granted authority to make key decisions with regard to Minimal Creditable Coverage (MCC), affordability, waivers to individual mandate, and other aspects of health reform implementation The Massachusetts Health Connector

5. Massachusetts Health Reform: Three Years Later • Status • Estimate of over 400,000 newly insured • Rate of un-insurance in MA estimated at 3%, compared to the national average of 15.5% • 99,000 more MassHealth members • 160,000 Commonwealth Care members • Challenges • Costs are somewhat higher than expected • Keeping insurance costs affordable will require substantial changes • Impact of National Health Reform?

6. MassHealth - The Massachusetts Medicaid Program Administered under an 1115 Waiver Authority More than 1.2 million residents enrolled 200,000 members with disabilities age 19-64 MassHealth and Health Reform: Centralized enrollment process: Use of the state’s Medicaid (MA21) eligibility system to process application for subsidized health programs. Use of the state’s Medicaid (MA21) eligibility system to process applications with built-in logic to enroll applicants in the “richest” benefit category of assistance. Applicants with disabilities continue to have same access to established MassHealth plans for members with disabilities. Applicants with disabilities not eligible for MassHealth, without comparable coverage, i.e. Medicare, have access to Commonwealth Care and Commonwealth Choice. MassHealth (Medicaid) and MA Health Reform

7. The Massachusetts Medicaid Program: CommonHealth • CommonHealth is the Massachusetts Medicaid Buy-In Benefit Plan. • CommonHealth was created a state program as part of the Dukakis Universal Health Care Act of 1988. • CommonHealth included under State 1115 Waiver as of 1997. • Currently, more than 20,000 Medicaid Buy-In enrollees in 3 subgroups: • 12,000 CommonHealth Working Adults age 19+ • 5000 CommonHealth Non-Working Adults age 19-64 • 3000 CommonHealth Children <19 • Note: the CommonHealth Working Adults program (“Buy-in”) requires 40 hours work/month and has no income limit or asset test.

8. The Massachusetts Medicaid Program: Plans for People with Disabilities

9. Massachusetts took specific measures to ensure ongoing access to programs for people with disabilities. Single application for MassHealth and subsidized plans Centralized eligibility and enrollment process No change for MassHealth members with disabilities Members with disabilities continue to have access to MassHealth plans which offer community long-term care services not provided by private insurers or Medicare. Access can include enrollment in multiple plans with MassHealth as wrap coverage. Massachusetts Health Care Reform Access for People with Disabilities

10. Some adult applicants with disabilities age 19-64, may be enrolled in either Commonwealth Care or Commonwealth Choice plans if: Their household income exceeds the MassHealth Standard threshold of 133% FPL, and They are not working 40 hour or more each month, and They do not have access to comparable coverage like Medicare or private insurance. Commonwealth Care and Commonwealth Choice plans do not offer community long term care services like personal care attendant services. Massachusetts Health Care ReformImpact on People with Disabilities

11. Massachusetts had an established Medicaid program for people with disabilities, age 19-64, with a 133% FPL financial eligibility. The CommonHealth Working (MBI) has work requirement, an income related premium but no income limits or asset test. Massachusetts negotiated with CMS to ensure existing Medicaid programs for people with disabilities would remain intact. Focus on outreach and centralized enrollment systems provided increased access to information for applicants and members. Same application and state’s Medicaid (MA21) eligibility system used to process applications for subsidized health programs. Multiple mechanisms for program enrollment Standard application available on web Use of Virtual gateway by providers and community groups Factors Contributing to Success inMassachusetts

12. Health Care Reform: Implications for People with Disabilities and Medicaid Buy-Ins • The impact of the state and national health reform will vary dependent upon each state’s existing Medicaid and MBI programs. • Emphasis on outreach and centralized enrollment systems can facilitate access to information for applicants and relatively smooth transition for members. • Non-Medicaid “Insurance Exchange” products may need to take on cost and care needs of people with disabilities.

13. Annette Shea, MEd Senior Project Director for Medicaid Disability and Employment Initiatives Annette.Shea@umassmed.edu 508-856-2654 Jay Himmelstein MD, MPH Professor, Family Medicine and Community Health Director, Massachusetts Medicaid Infrastructure and Comprehensive Employment Opportunities Grant Jay.Himmelstein@umassmed.edu 508-856-5763 Questions?