1. 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

2. 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

3. 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

4. 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

5. 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

6. Commonwealth Care
Approx. 140,000 Individuals may be eligible for Commonwealth Care
Below 100 % of FPL
48,000 UCP members
6, 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

7. 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

8. CommCare Membership Churn

9. Commonwealth Care Enrollment
Call volume continues to be high per day average

10. 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

11. 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)

12. 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

13. 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