Commonwealth Care The Health Connector’s subsidized health insurance program Rosemarie Day Deputy Director Friday, January 22, 2010 National Conference.

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Presentation transcript:

Commonwealth Care The Health Connector’s subsidized health insurance program Rosemarie Day Deputy Director Friday, January 22, 2010 National Conference on Health Care Reform in Massachusetts

Launched in two phases October 1, 2006: enrollment begins for eligible individuals who are not responsible for a monthly premium (income below 100% FPL) January 1, 2007: enrollment expands to eligible individuals who are responsible for a monthly premium (income at 100%-300% FPL). Making the market work better: Set standards Increase transparency Simplify consumer experience Create more affordable options Standardize benefit plans

Rapid ramp-up - exceeded expectations!

Eligibility and sliding scale of premium contributions Eligibility criteria: Must have gross income below 300% FPL; Must be a Massachusetts resident; Must be a US citizen or qualified alien; Must be without access to any other form of subsidized coverage (including employer-subsidized coverage); and Must be an adult (children qualify for MassHealth). Commonwealth Care minimum monthly premiums (effective July 1, 2009) Income (% of FPL) Min. monthly premium 0 - 150% $0 150.1% - 200% $39 200.1% - 250% $77 250.1% - 300% $116

CommCare members by Plan Type (FY10 Q1)

CommCare members by gender and age (for FY10 Q1)

Of the 408,000 newly insured Mass residents (as of 6/09), 44 percent have coverage through CommCare Source: Mass Division of Health Care Finance and Policy (DHCFP), Nov 2009

Outsourced model and applications Function Outsourced to Eligibility determinations MassHealth (Virtual Gateway and paper) Enrollment and customer service Dell Perot Premium billing Dell Perot (new system) Making the market work better: Set standards Increase transparency Simplify consumer experience Create more affordable options Standardize benefit plans

Members served by five Managed Care Organizations (FY10 Q1 shown below)