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State legislative & health reform updates from MLRI

1.  State budget for FY 2013. A conference committee is now considering differences between the House & Senate budget for the fiscal year starting July 1. A detailed summary of the health care provisions in the two bills from MMPI, Mass Budget & MLRI is available here: https://bluecrossmafoundation.org/publication/fiscal-year-2013-house-and-senate-budget-comparison-brief
Some key issues for low income families in the 2 bills:

Delays. The Senate, unlike the House, provides full funding for a new line item to address delays at MassHealth    

*  Adult Dental. Neither bill restores adult dental coverage, but the Senate at least restores composite fillings for front teeth.

Now is the time to communicate with the conference committee in support of these & other priorities.

2.  National health reform –the Affordable Care Act

Supreme Court –A decision is expected this month from the US Supreme Court upholding some, none, or all of the Affordable Care Act. An interesting article on the Health Affairs blog speculates on how states like Massachusetts that are fully committed to implementing the ACA may fare depending on how the court rules. https://www.healthaffairs.org/do/10.1377/hblog20120604.019983/full/

State implementing legislation – A supplemental budget designated the Connector as the state’s Exchange under the ACA. C. 96, § 7 St. 2012 May 11, 2012). A second supplemental budget (H. 4132) that would authorize several other key steps toward implementation is now pending in conference but there are no differences on the following three important provisions affecting low income people:

***  Authorizing the Connector to make premium assistance payments and payments to offset cost sharing from the Commonwealth Care Trust Fund in order to increase health coverage. This will enable the Connector to continue subsidizing coverage if Commonwealth Care is replaced by other forms of subsidized insurance at less cost to the state under the ACA.

***  Authorizing the Secretary of EOHHS to establish a Basic Health Program under the ACA. This option will enable the state to replace Commonwealth Care with a similar program for those up to 200% of poverty using primarily federal funding available through the ACA.

***  Authorizing the Secretary of EOHHS to establish a demonstration program for disabled individuals aged 21 to 64 dually eligible for MassHealth and Medicare. This demonstration has been in the planning phase for over a year with intensive scrutiny from the disability community. Certain key consumer protections for the demonstration are included in the pending cost containment bills rather than the pending supp. (More later on how the cost containment bills may affect MassHealth recipients).

A more comprehensive bill implementing the Affordable Care Act is expected early in 2013.

3.  Commonwealth Care.

Open enrollment. Commonwealth Care is in an open enrollment period from June 1 to June 22, 2012.  This is the period in which individuals enrolled in Commonwealth Care can freely switch managed care organization (MCOs) effective July 1. People who may want to switch plans include 1. anyone unhappy with their current MCO who doesn’t want to hassle with showing good cause to change MCOs; 2. People who, if they stay with their current MCO, will have to pay a higher premium than if they switch to another MCO, and 3. People under 100% of poverty who initially had a limited choice of MCO. For more information on open enrollment, see mahealthconnector.org or call Commonwealth Care at 877-623-6765.

Eligibility reviews for former Bridge members. Starting June 25 2012 and continuing through July, MassHealth will be sending review forms to former Bridge members who are now enrolled in Commonwealth Care. There are about 8,000 of these folks, all legal immigrants who were in Bridge from August 2009 until this spring when Commonwealth Care was restored (thanks to the Finch case). Having gone through so many changes in coverage since 2009, and not having been reviewed since then, these individual are in real danger of losing coverage for not returning their forms. Please be on the look out for them.