Commonwealth Care Program Update Before presenting information - Setting context - What this meeting is….is not - Commonwealth Care specific related to but will not cover in depth…Health Care Reform etc… May 10, 2007

Program Overview Commonwealth Health Insurance Connector was created as part of the Health Care Reform legislation Creation of the Commonwealth Care program was a key element of the legislation Implemented October 1, 2006 Serves individuals who are under 300% of the FPL

Commonwealth Care - Administration Private insurance plans offered exclusively through Medicaid Managed Care Organizations (MMCOs) for first three years The Connector serves as the exclusive administrator of Commonwealth Care premium assistance program Works closely with Medicaid program to determine eligibility Refers to move from $$ out of the Free Care Pool

Role of Autoassignment Autoassignment is a key part of the program design Supports both programmatic and contract goals Rate negotiation & enrollment MassHealth (sister program) has used autoassignment for a number of years

Basics Utilized for those individuals in the Uncompensated Care Pool that were determined eligible for non-premium paying categories Individuals were notified of their eligibility and sent a detailed enrollment packet Utilize a 14 – 14 – 60 day model for enrollment and plan changes

Commonwealth Care Approx. 140,000 Individuals may be eligible for Commonwealth Care Below 100 % of FPL 48,000 UCP members 6,000 Unknown to UCP Between 100% - 300% of FPL 62,000 UCP members 24,000 Unknown to UCP Total Commonwealth population 6,400,000 Approximately 320,000 uninsured Approx. 150,000 individuals may be eligible for Commonwealth Care

Enrollment Breakdown 69,000 enrolled as of May 1 53,768 enrolled in Plan Type 1 (autoassigned) Plan Types 2, 3 & 4 (15,560) Autoassignments were completed over a three month period Allowed for better management of call volume & enrollment

CommCare Membership Churn

Commonwealth Care Enrollment Call volume continues to be high- 1500 per day average

Autoassignment Methodology Commonwealth uses Service Areas to determine coverage (38 areas) Full coverage of the State Only a few areas only have one MCO available Enrollment system (MMIS) is programmed to assign people – no manual intervention is required

MCO Negotiations Initial Connector position was to auto assign all enrollees to the lowest bidder in a service area Based on MMCO negotiations, Connector modified proposal as follows: Any MMCO within 3% of the lowest bidder, will also receive some percentage of the auto-assigned enrollees The ratio of enrollees assigned to the lowest in comparison to the others will be 3:1 Composite calculation will be performed at the beginning of the contract using estimated enrollment again on July 1 using actual enrollment (prospective only)

Assignment Model # of MCOs 2 3 4 % of enrollees – lowest bid 75% 60% 50% % of enrollees – 2ND lowest bid 25% 20% % of enrollees – 3RD lowest bid NA 15% % of enrollees – 4TH lowest bid Only two MMCOs were within the 3% range for the 10/1/2006 effective date

Challenges Were only able to achieve a 50% self-selection rate for first group Working on ways to increase this 60 Day Lock in policy has caused challenges in some areas Has taken time to find the right balance on MCO marketing to members