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Health Update: FY 2014 budget, Affordable Care Act, Open Enrollment & More

Sorry for the long-winded update to follow but a lot has happened in the last few months!

FY 2014 Budget, Affordable Care Act, Open Enrollment & More

1.       On July 15, the Governor signed the FY 2014 budget for the fiscal year starting July 1, 2013.

·         The FY 2014 budget (c. 38 St. 2013) includes sufficient funds to restore coverage for dental fillings to adults on MassHealth & for poverty level adults in the Connector for about 6 months of the fiscal year –dental coverage will likely be expanded in January. Section 159 and 4000-0700. Currently, adult dental only includes preventive (cleaning) & emergency services & fillings for the two front teeth.

·         The budget also includes full funding for expanded MassHealth coverage for an estimated 325,000 adults under 65 starting in January 2014.

·         Funding for the Connector should be enough to make new forms of Connector coverage in 2014 as affordable as Commonwealth Care is now IF the cigarette tax increase that is part of a separate transportation bill is enacted (H. 3535). Other aspects of the transportation bill have so far stalled its enactment.

·         The Medical Security Program (MSP) that provides insurance to individual collecting unemployment insurance is repealed on Dec. 31, 2013. Sections 111 and 215. People on MSP should be able to transition to MassHealth, or the Connector, but they will have to file a new application between October and December to avoid a gap in coverage. Also, there will be no new program in 2014 to reimburse unemployed workers for the cost of COBRA coverage the way MSP Premium Assistance does now.


2.       The Office of Medicaid and CMS have signed contracts with 3 plans to offer OneCare to dually eligible individuals with disabilities age 21-64 starting October 1.

·         The 3 OneCare plans will be: Commonwealth Care Alliance, Fallon Total Care, and Network Health.

·         OneCare plans promise to better coordinate MassHealth and Medicare benefits for people age 21-64 who have both and to offer additional services including full dental.

·         Voluntary enrollment begins in September with coverage to start October 1.

·         The state still plans to “passively enroll” dually eligible individuals (with the right to opt out) in those counties with a choice of at least 2 plans: Suffolk, Worcester, Hampshire, and Hampden. Counties with only one plan will not have passive enrollment. Five counties will have no participating plans: Berkshire, Bristol and the Islands. The first wave of passive enrollment is expected to start in November effective for January 1, 2014.

·         The state is also asking for responses by July 29 for bidders interested in operating an Ombudsman program for OneCare enrollees.

·         For more information, visit www.



3.       On July 5, the Governor signed the state law to implement key provisions of the ACA, c.35 St. 2013.

In addition to various changes affecting the private insurance market that were needed to comply with the ACA, the Act makes the following key changes to public programs:

·         Repeals Commonwealth Care effective January 1, 2014. Section 35. Of the 200,000 now enrolled, about half will automatically go to MassHealth and the remainder will have to reapply for new Connector coverage.

·         Authorizes a new MassHealth coverage for an estimated 325,000 adults with income up to 133% of poverty starting January 1, 2014. Section 19. It does not repeal authority for MassHealth Basic, Essential and the Insurance Partnership, but EOHHS plans to eliminate these programs after Dec. 31, 2013.

·         Clarifies language enacted in 2012 authorizing the Connector to provide added premium and cost sharing subsidies for individuals with income up to 300% of poverty in January 2014. Section 78, 79, 83-85. This is the “state wrap” designed to make new forms of Connector coverage as affordable as Commonwealth Care.

·         Expands coverage to 19 and 20 year olds under 150% of poverty in 2014. Section 18.

·         Makes changes to permit enhanced benefits for pregnant women. Sections 26 and 26A.

·         Authorizes state-funded coverage in MassHealth for PRUCOL immigrants who will not be eligible for the Connector after January 1, 2014. This protects certain AWSS now in Commonwealth Care. Section 13.

·         Authorizes a new kind of MassHealth premium assistance for individuals who are not eligible for premium tax credits through the Connector based on offers of employer-sponsored insurance with income up to 300% of poverty. Section 20. This may protect certain employees now in the Insurance Partnership and others.


4.       On June 4 the Office of Medicaid submitted amendments to the 1115 demonstration to implement changes related to the ACA.

The amendments and a revised ACA Transition Plan propose the following major eligibility-related changes for January 2014 subject to CMS approval:

·         MassHealth Essential, Basic, the Insurance Partnership, Commonwealth Care and the Medical Security Program will end after Dec. 31, 2013.

·         Most individuals with income up to 133% of poverty & Medicaid-eligible immigration status enrolled in the programs that are ending will be automatically switched over to MassHealth. However, individuals in the Medical Security Program will have to apply for MassHealth between October and December to remain insured on January 1.

·         Some individuals will be newly eligible for MassHealth Standard including:

o   19 & 20 year olds up to 150% of poverty

o   Dept. of Mental Health eligible people now in Basic (about 400)

o   HIV positive individuals up to 133% of poverty (about 1000)

o   Other “medically frail” individuals

·         About 325,000 will be eligible for a new type of MassHealth called CarePlus. CarePlus covered benefits will not be as good as Standard but they will be better than either Commonwealth Care, Basic or Essential. The state will be releasing a proposed state plan amendment describing the new benefits for public comments soon.

·         CarePlus will only be offered through MCOs; there will be no PCC Plan option. This means about 60,000 MassHealth Essential members and about 7,000 EAEDC recipient (MassHealth Basic members) who are now enrolled in PCC Plans will have to switch.

·         Most legal permanent residents still in the 5-year waiting period for Medicaid and other “aliens with special status”, people with income over 133% of poverty, and all Medical Security Program enrollees will have to reapply after October 1, 2013 and reenroll in new Connector coverage to remain insured in 2014.

o   We don’t yet know when current Virtual Gateway users will be able to help the estimated 120,000 people slated to lose coverage on January 1 to reapply through the new on-line system –word is it may not be until Dec. 15!

·         Anyone applying or up for renewal after Jan 1 will have income measured under a new income methodology based on “modified adjusted gross income” (MAGI). Individuals with disabilities will use current household rules, but the new MAGI income counting rules. MAGI will not apply to cash welfare recipients, the elderly or those seeking long term care.

·         The proposed amendments and Transition plan are posted here:


5.       The Office of Medicaid has asked Managed Care Organizations to bid on the delivery of a new kind of MassHealth called CarePlus to begin January 1

·         Bids from plans are due August 7, and we should know by the fall which MCOs will be offering CarePlus.


6.       The Connector has given “conditional” approval to new plans that will be available after January 1.

·         At its June board meeting the Connector gave conditional approval to 10 carriers to offer plans for sale through the Connector in 2014. The 10 plans include all those now participating in Commonwealth Care and Commonwealth Choice and a new company, Minuteman Health.

·         The Dept. of Insurance must now review the rates proposed by the carriers and satisfaction of other requirements.

·         In September, the Connector board will decide which plans will receive final approval and which plans will be eligible as “wrap” plans. Only “wrap” plans will be eligible for added state subsidies to bring premiums and cost sharing in line with current Commonwealth Care standards.



7.       The Connector has awarded 10 Navigator grants to organizations that will help people enroll, and 35 Community Health Centers have gotten federal grants to help with enrollment.

·         At its July board meeting, the Connector announced $1 million in “Navigator” grants to 10 organizations that will do outreach and help people to enroll. The grants ranged from $304,000 to the Boston Public Health Commission to $40,000 to Ecu-HealthCare in North Adams.

·         Federal outreach & enrollment grants were awarded to 35 community health centers in Massachusetts ranging from $253,000 to the East Boston CHC to $60,000 to the City of Springfield.


8.       Open enrollment is July 1 to August 15 for Commonwealth Choice and other coverage in the individual market. It is once more the time when people who want to buy coverage in the individual/nongroup market or change to a different plan to do so. This applies to Commonwealth Choice (private insurance coverage) not Commonwealth Care (subsidized coverage). For more information, visit


9.       Open enrollment is October 1, 2013 to March 31, 2014 for new coverage under the Affordable Care Act. There will be a second open enrollment period under the Affordable Care Act starting in October for coverage to begin no earlier than January 1. There will be new plans available in the Connector starting January 1 and new forms of subsidies available. Both Commonwealth Choice and Commonwealth Care will be replaced by the new plans. For more on open enrollment periods in 2013 and 2014, visit


10.   Medicaid director Dr. Julian Harris’ left for D.C.(to Office of Management & Budget);  Kristin Thorne, Deputy Director for Administration is interim Director.

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