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

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 2

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 3

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 Key features of the ACA 4

ACA strengthens state finances 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 5 Enhances federal assistance for coverage that the Commonwealth has already been providing − 75%-100% federal matching for Medicaid expansion population in , then 90% federal matching starting in 2020 − Federal subsidies for legal immigrants – currently covered at 100% state cost

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) 6

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 7

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 8

Tax Credits ConnectorCare ACA preserves and expands access to affordable health insurance Federal Poverty Guidelines *For bigger households or more information, go to aspe.hhs.gov/poverty, MAhealthconnector.org or HealthCare.gov Medicaid Expansion (Care Plus) ConnectorCare (AWSS Only) 0% 133% 300% 400% 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 % FPL (lawfully present immigrants % 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” MassHealth Health Connector

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 23 rd,

Key changes at MassHealth 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 11 MassHealth ProgramPopulation StandardLower-income kids & young adults age 19-20, parents, pregnant women, disabled individuals, certain adults with special health care needs, and elder adults (65+) CommonHealthHigher-income people with disabilities CarePlus NEWLow-income adults Family AssistanceHigher-income kids, individuals with HIV, certain immigrants Small Business Employee Premium Assistance NEW Qualifying employees of small businesses MassHealth LimitedImmigrants ineligible for other MassHealth programs because of their immigration status Children’s Medical Security PlanKids who are not eligible for any other more comprehensive MassHealth benefit 2014 MassHealth Programs2014 MassHealth Programs

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 12

Key changes at the Health Connector 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 13 Health Connector ProgramPopulation Qualified Health Plan (QHP) NEW A health plan available through the Health Connector to all Massachusetts residents that are U.S. citizens, nationals or otherwise lawfully present and are not in jail. Qualified Health Plan with Premium Tax Credit NEW Middle-income individuals and families (earning at or below 400% FPL) that meet all the requirements for purchasing a QHP may be eligible for a premium tax credit to lower the cost of their monthly premiums if they also do not have access to other public health insurance programs (e.g., Medicare, Medicaid) and do not have access to ‘affordable’, comprehensive coverage from their employer. ConnectorCare NEWLower-income individuals and families (earning at or below 300% FPL) that meet all the requirements for purchasing a QHP with a premium tax credit may be eligible for a ConnectorCare plan, which through a mix of state and federal funding, has even lower monthly premiums and co-pays than a standard QHP Health Connector Programs2014 Health Connector Programs

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

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 15

What is the new HIX-IES system? 16 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

What will applicants through the Health Connector see beginning October 1? 17 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

Where people can go for help 18 Keep them informed! Send them to MAhealthconnector.org to sign up for 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 − Health Care For All HelpLine ( ) − Health Connector Customer Service (1-877 MA ENROLL ( ) or TTY ) − General Health Connector and MassHealth HelpLine (1-855-MA-4-HLTH ( ), TTY ) 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?

Appendix – List of Navigators 20 Boston Public Health Commission 1010 Massachusetts Avenue Boston, MA Phone: or Website: bphc.org/programs/cib/civicengag ement/mhl/Pages/Home.aspxbphc.org/programs/cib/civicengag ement/mhl/Pages/Home.aspx Region(s) covered: City of Boston Caring Health Center 1145 Main Street, Suite 205 Springfield, MA Phone: Website: caringhealth.orgcaringhealth.org Region(s) covered: Springfield metro area Community Action Committee of Cape Cod & Islands, Inc. 372 North Street Hyannis, MA Phone: or Website: cacci.cccacci.cc Region(s) covered: Cape Cod, Martha’s Vineyard, Nantucket, Cuttyhunk Island Ecu-Health Care 71 Hospital Avenue North Adams, MA Phone: Website: ecuhealth.boxcarexpress.comecuhealth.boxcarexpress.com Region(s) covered: Northern Berkshire County Greater Lawrence Community Action Council 305 Essex Street Lawrence, MA Phone: Website: glcac.orgglcac.org Region(s) covered: Lawrence, Methuen, Andover, North Andover Hilltown Community Health Care Centers 58 Old North Road Worthington, MA Phone: Website: hchcweb.orghchcweb.org Region(s) covered: The Hilltowns of western MA (11 towns in Hampshire and Hampden counties) Joint Committee for Children’s Health Care in Everett 484 Broadway, Room 27 Everett, MA Phone: or Website: jcchce.orgjcchce.org Region(s) covered: Everett, Chelsea, East Boston, Malden, Revere, Somerville Manet Community Health Center 110 West Squantum Street North Quincy, MA Phone: Website: manetchc.orgmanetchc.org Region(s) covered: South Shore – incl. Quincy, Weymouth, Braintree, Canton, Milton MAPS – MA Alliance of Portuguese Speakers 1046 Cambridge Street Cambridge, MA Phone: Website: maps-inc.orgmaps-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 Endeavors 166 William Street New Bedford, MA Phone: Website: paceinfo.orgpaceinfo.org Region(s) covered: Greater New Bedford – incl. New Bedford, Fairhaven, Dartmouth, Acushnet, Rochester, Mattapoisett, and Marion

Appendix – List of Certified Application Counselors (as of September 2013) 21 Allston Joseph M Smith Community Health Center 287 Western Avenue Allston, MA Website: Athol Athol Memorial Hospital 2033 Main Street Athol, MA Website: Attleboro Sturdy Memorial Hospital 211 Park Street Attleboro, MA Website: Beverly Northeast Hospital Corporation (Beverly Hospital, Bay Ridge Hospital & Addison Gilbert Hospital) 85 Herrick Street Beverly, MA Website: Boston Beth Israel Deaconess Medical Center 330 Brookline Avenue Boston, MA Website: Boston Children’s Hospital 300 Longwood Avenue Boston, MA Website: Boston Health Care for the Homeless 780 Albany Street Boston, MA Website: Boston Medical Center One Boston Medical Center Place Boston, MA Website: Community Care Alliance 330 Brookline Avenue BR-270 Boston, MA Website: Healthcare Financial 200 High Street, 6th Floor Boston, MA Website: Massachusetts General Hospital 55 Fruit Street Boston, MA Website: North End Community Health Committee Inc. North End Watherfront Health 332 Hanover Street Boston, MA Website: South Cove Community Health Center 885 Washington Street Boston, MA Website: Southern Jamaica Plain Health Center 75 Francis Street Boston, MA Website: Tufts Medical Center 800 Washington Street Boston, MA Website:

Appendix – List of Certified Application Counselors (as of September 2013) (cont’d) 22 Brockton Brockton Neighborhood Health Center 63 Main Street Brockton, MA Website: Signature Healthcare Brockton Hospital 680 Centre Street Brockton, MA Website: Burlington Fishing Partnership Support Services 30 Chestnut Avenue, Suite #2 Burlington, MA Website: Cambridge Mount Auburn Hospital 330 Mount Auburn Street Cambridge, MA Website: Charlestown MGH Charlestown Healthcare Center 73 High Street Charlestown, MA Website: Partners Healthcare System Inc. Schraft Center 529 Main Street Charlestown, MA Website: Chelsea MGH Chelsea Healthcare Center 151 Everett Avenue Chelsea, MA Website: Dorchester Bowdoin Street Health Center 230 Bowdoin Street Dorchester, MA Website: Codman Square Health Center 637 Washington Street Dorchester, MA Website: Dorchester House Multi-Service Center 1353 Dorchester Avenue Dorchester, MA Website: Harbor Health Services Inc. Geiger Gibson Community Health Center 250 My Vernon Street Dorchester, MA Website: Harbor Health Services Inc. Neponset Health Center 398 Neponset Avenue Dorchester, MA Website: Harvard Street Neighborhood Health 632 Blue Hill Avenue Dorchester, MA Website: Upham’s Corner Health Committee, Inc. 500 Columbia Road Dorchester, MA Website: East Boston East Boston Neighborhood Health Center 10 Grove Street East Boston, MA Website:

Appendix – List of Certified Application Counselors (as of September 2013) (cont’d) 23 Fall River Healthfirst Family Care Center 387 Quarry Street, Suite 100 Fall River, MA Website: Stanley Street Treatment & Resources Inc. (Family Healthcare Center) 386 Stanley Street Fall River, MA Website: Framingham MetroWest Medical Center 115 Lincoln Street Framingham, MA Website: Gardner Heywood Memorial Hospital 242 Green Street Gardner, MA Website: Great Barrington Community Health Programs 444 Stockbridge Road PO Box 30 Great Barrington, MA Website: Fairview Hospital 29 Lewis Avenue Great Barrington, MA Website: Greenfield Community Health Center of Franklin County 489 Bernardston Road Greenfield, MA Website: Holyoke Holyoke Health Center 230 Maple Street PO Box 6260 Holyoke, MA Website: Holyoke Medical Center Inc. 575 Beech Street Holyoke, MA Website: Hyannis Cape Cod Healthcare 25 Communication Way Hyannis, MA Website: Duffy Health Center 94 Main Street Hyannis, MA Website: Harbor Community Health Center – Hyannis Ellen Jones Community Dental Center 30 Elm Avenue Hyannis, MA Website: Jamaica Plain Brookside Community Health Center 3297 Washington Street Jamaica Plain, MA Website: Southern Jamaica Plain Health Center (licensed by Brigham and Women’s Hospital) 640 Centre Street Jamaica Plain, MA Website: Lawrence Lawrence General Hospital 1 General Street PO Box 189 Lawrence, MA Website:

Appendix – List of Certified Application Counselors (as of September 2013) (cont’d) 24 Lowell Lowell Community Health Center 161 Jackson Street Lowell, MA Website: Lowell General Hospital 295 Varnum Avenue Lowell, MA Website: Lynn Lynn Community Health Center 269 Union Street Lynn, MA Website: Marlborough Marlborough Hospital 157 Union Street Marlborough, MA Website: Mashpee Community Health Center of Cape Cod 107 Commercial Street Mashpee, MA Website: Mattapan Mattapan Community Health Center 1575 Blue Hill Avenue Mattapan, MA Website: Medford Cambridge Health Alliance 101 Station Landing Medford, MA Website: Hallmark Health Systems Inc. 170 Governors Avenue Medford, MA Website: Methuen Greater Lawrence Family Health Center One Griffin Brook Drive, Suite 101 Methuen, MA Website: Milford Milford Regional Medical Center 14 Prospect Street Milford, MA Website: Needham Beth Israel Deaconess Needham Hospital 148 Chestnut Street Needham, MA Website: New Bedford Greater New Bedford Community Health Center 874 Purchase Street New Bedford, MA Website: Southcoast Hospitals Group 101 Page Street New Bedford, MA Website: Newburyport Anna Jaques Hospital 25 Highland Avenue Newburyport, MA Website: Pittsfield Berkshire Medical Center Berkshire Health Systems 510 North Street Pittsfield, MA Website:

Appendix – List of Certified Application Counselors (as of September 2013) (cont’d) 25 Plymouth Jordon Hospital 275 Sandwich Street Plymouth, MA Website: Quincy Manet Community Health Center 110 W Squantum Street Quincy, MA Website: Roslindale Boston Medical Center d/b/a Greater Roslindale Medical & Dental Center 4199 Washington Street Roslindale, MA Website: Roxbury The Dimock Center 55 Dimock Street Roxbury, MA Website: Whittier Street Health Center 1290 Tremont Street Roxbury, MA Website: Salem North Shore Community Health, Inc.. 27 Congress Street Salem, MA Website: North Shore Medical Center (Partners HC) 81 Highland Avenue Salem, MA Website: South Boston South Boston Community Health Center 409 W Broadway South Boston, MA Website: Southbridge Harrington Hospital 100 South Street Southbridge, MA Website: Springfield Baystate Health 759 Chestnut Street Springfield, MA Website: Caring Health Care 1145 Main Street Springfield, MA Website: Wellfleet Outer Cape Health Services PO Box 1413 Wellfleet, MA Website: West Tisbury Island Health Inc. PO Box 1619 West Tisbury, MA Website: Westfield Noble Hospital 115 West Silver Street Westfield, MA Website: Weymouth South Shore Hospital 55 Fogg Street Weymouth, MA Website:

Appendix – List of Certified Application Counselors (as of September 2013) (cont’d) 26 Worcester Community Healthlink 72 Jaques Avenue Worcester, MA Website: Edward M Kennedy Community Health Center 2000 Century Drive Worcester, MA Website: Family Health Center of Worcester 26 Queens Street Worcester, MA Website: Saint Vincent Hospital 123 Summer Street Worcester, MA Website: UMass Memorial Medical Center 1 Biotech 365 Plantation Street Worcester, MA Website: Check out MAhealthconnector.org for updates to this list