1. MassHealth Premiums Premium structures and operational issues in the MassHealth program Christy Bonstelle, Sr. Policy Analyst, Office of Medicaid Massachusetts Executive Office of Health and Human Services June 2004

2. MassHealth 1115 Waiver Coverage Types Base – Standard – Prenatal – Limited Expansion – Family Assistance – CommonHealth – Basic – Essential

3. Initial Premium Groups Family Assistance – Covered: Children, incomes 150%-200% FPL, certain adults, incomes <=200% FPL – Monthly Premium Schedule: $12/Child with a maximum of $36/Family CommonHealth – Covered: Disabled individuals, incomes > 133% – Monthly Premium Schedule: For those >=150% FPL, sliding scale premiums

4. Additional Premium Groups (Introduced in November, 2003) Standard Children – Covered: Children, incomes <150% FPL – Monthly Premium Schedule: For those over 6 years of age and >=133% FPL, $12/Child with a maximum of $15/Family Standard Disabled – Covered: Disabled individuals, incomes <= 133% – Monthly Premium Schedule: For those >=114% FPL, sliding scale premiums

5. Current MassHealth Premium Structure Family AssistanceCommon Health Standard Children Standard Disabled 100%- 114% $12/child, $15 family max; $27/childless adult, $15/ family None 114%- 133% $12/ family 133%- 150% $12/child, $15 family max N/A 150%+ $12/child, $36 family max; $27/childless adult Sliding scale N/A

6. “Day-to-Day” Operations Collecting premiums Protecting eligibility Providing customer service

7. Collecting Premiums Premiums collected by an internal billing unit Billing unit must coordinate across agencies Premium billing process is labor intensive Forms of payment accepted Forms of payment that are easy for members

8. Protecting Eligibility Member rights Providing written information Coordination between eligibility and billing units Complex families Changes in family situation Payment plans and hardship waivers

9. Waivers for “Extreme Financial Hardship” Defining extreme financial hardship Tracking, reviewing and granting or denying waiver applications Use of application to report change in family status

10. Customer Service “Why do I have a premium?” (Eligibility) “How do I pay my premium?” (Billing) Limiting “bouncing” back and forth

11. Points to Consider when Introducing Premiums Complexity of premium schedule Efficiency of premium billing and collection process The link between premium collection and member eligibility