1. 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

2. 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

3. Rapid ramp-up - exceeded expectations!

4. 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
150.1% - 200%
$39
200.1% - 250%
$77
250.1% - 300%
$116

5. CommCare members by Plan Type (FY10 Q1)

6. CommCare members by gender and age (for FY10 Q1)

7. 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

8. 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

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