1. Basic Benefits Training December 10, 2014 Transitions in Health Care Reform 1

2. Major ACA Improvements in MA MassHealth eligibility up to 133% -(138% MAGI) Help paying for health insurance up to 400% FPL Fewer gaps in coverage One-stop-shopping for health and dental insurance (online application) 2

3. Health Insurance Connector Authority Massachusetts’ Exchange or Marketplace Place to buy private insurance called Qualified Health Plans Subsidized and unsubsidized Must be US citizen or “lawfully present” immigrant 3

4. New ACA Subsidized Coverage Construct

5. Coverage Types Under ACA in MA MassHealth o Standard o CommonHealth o CarePlus o Family Assistance o Small Business Employee Premium Assistance o Limited o CMSP Health Connector o Qualified Health Plan (QHP) only o QHP with Premium Tax Credit (PTC) o ConnectorCare plans (QHPs which include additional premium and cost sharing subsidies) Health Safety Net

6. 2014 MassHealth Programs 6

7. Coverage Types That Were Discontinued   The plans that were discontinued: o MassHealth Basic o MassHealth Essential o Medical Security Program (Network Health Extend, ending on January 31st) o Commonwealth Care (ends January 31 st ) o Insurance Partnership  All the above mentioned populations are eligible for new programs under the ACA with similar or richer benefits as compared with the benefits they received.

8. Static Populations No Change in eligibility post January 1, 2014 8

9. New ways of counting income Modified Adjusted Gross Income (MAGI) – Applies to almost everyone except Seniors eligible for MassHealth based on age People eligible for MassHealth based on need for long term care People for whom MassHealth does not make an income decision e.g. SSI, TAFDC & EAEDC recipients – More on MAGI from Vicky later this morning 9

10. Immigrants No change in federal Medicaid (MassHealth Standard) – “Qualified” adults eligible for MassHealth Standard & other benefits like US citizens – “Lawfully present” children under 19 up to 300% FPL & 19 & 20 year olds up to 150% FPL (new in 2014) are eligible for MassHealth like US citizens “Lawfully present” individuals are eligible for benefits through Connector like US citizens BBT on immigrant eligibility March 12, 2015 See “Understanding ACA: Non-citizen eligibility for health benefits” in on-line materials 10

11. What happened in 2014? Adults under 133% FPL successfully moved from other programs to MassHealth CarePlus Most new applicants stuck –computer breakdown – Commonwealth Care extended to Jan. 31, 2015 – US citizens & eligible immigrants given “temporary” MassHealth Standard – Ineligible immigrants given “temporary” MassHealth Limited 11

12. Open enrollment is from November 15, 2014-February 15, 2015. Who should submit a new application? If you or a family member is a Health Connector member or a temporary MassHealth member, you need to submit a new application to stay covered. Health Connector Qualified Health Plan coverage (including people receiving ConnectorCare and Advanced Premium Tax Credits) ends December 31st Commonwealth Care coverage ends on January 31st Temporary MassHealth coverage ends based on date of enrollment: January 15th, January 31st or February 15th 12

13. What we need to accomplish during the 2015 Open Enrollment period: Open Enrollment 2014-2015: Transitioning Populations Currently Enrolled PopulationsCount (as of 9/8/2014) End Date of Existing Coverage If eligible for Connector Coverage, Deadline to Apply and Select a Plan (to avoid gap in coverage) If eligible for Connector Coverage, Payment Due Date Qualified Health Plan (QHP) ~33K12/31/201412/23/2014 Commonwealth Care and Network Health Extend (formerly Medical Security Plan -MSP) ~100K1/31/20151/31/20151/23/2015 MassHealth Temporary Coverage – Wave 1 ~100K1/15/20151/15/201512/23/20141/23/2015 MassHealth Temporary Coverage – Wave 2 ~100K1/31/20151/31/20151/23/2015 MassHealth Temporary Coverage – Wave 3 ~100K2/15/20152/15/20152/15/20152/15/20152/23/2015 13

14. Qualified Health Plan GREY LETTER: Qualified Health Plan members will receive a grey letter and will need to fill out an application, pick a plan and make their first premium payment by December 23, 2014 Commonwealth Care YELLOW LETTER: Commonwealth Care/Medical Security Program (MSP) members will receive a yellow letter and will need to fill out an application, pick a plan and make their first premium payment by January 23, 2015 Temporary Coverage PURPLE LETTER: Temporary MassHealth coverage members that receive a purple letter, in order to avoid a gap in coverage, will need to fill out an application, pick a plan and make their first premium payment by December 23, 2014 Temporary Coverage BLUE LETTER: Temporary MassHealth coverage members that receive a blue letter, in order to avoid a gap in coverage, will need to fill out an application, pick a plan and make their first premium payment by January 23, 2015 Temporary Coverage GREEN LETTER: Temporary MassHealth coverage members that receive a green letter, in order to avoid a gap in coverage, will need to fill out an application and pick a plan by Feb. 15, 2015 and make their first premium payment by February 23, 2015 14

15. New hCentive End-to-End Consumer Experience 7 Participant creates account (Identity Mgt) 2. Apply 3. Verify Eligibility Qualified Health Plan QHP[c] Bill Pay Participant enters through a single Front Door for CCA & MassHealth (hCentive) 1. Front Door Portal or Phone Participant completes application (hCentive) QHP[a] Shop Application data is verified (Federal Hub) Participant provides verification if necessary Eligibility and MAGI program is determined (hCentive) Participant chooses plan – non state wrap (hCentive) Participant chooses plan – state wrap (hCentive) Participant is invoiced and pays bill (Dell) Participant receives Proof of Coverage Portal, Phone or Paper QHP[d] Enroll MH [a] Notification Participant is noticed (from hCentive to MassIT) Non-MAGI manual processing (Excel file to MA-21) Assessed to be non-MAGI Medicaid MH [b] Enrollment Eligibility information is sent to MMIS for enrollment QHP[b] Notification Participant is noticed for QHP (Dell) 15

16. Current MassHealth members receiving benefits through the following MassHealth programs DO NOT need to submit a new application during the Open Enrollment period but will be redetermined after Open Enrollment ends using MAGI rules – MassHealth Standard – CarePlus – Family Assistance – Limited (except for Temporary MassHealth Limited) – Health Safety Net – Children’s Medical Security Plan – CommonHealth 16 Not Subject to Open Enrollment

17. How should you apply? There are four ways to apply for health coverage beginning on November 15th: Online: www.MAhealthconnector.orgwww.MAhealthconnector.org By phone: 1-877-MA-ENROLL (1-877-623- 6765) In person: Get free in-person help with your application. Go to: https://bettermahealthconnector.org/get- help/ or call 1-877-MA-ENROLL (877- 623- 6765) to find help near you. https://bettermahealthconnector.org/get- help/ Paper application Kate will be covering more on these issues 17

18. Newly eligible for MH Standard Pregnant women formerly in Healthy Start-(all pregnant women (regardless of immigration status) up to 200% now in Standard Young adults 19-20 with income up to 150% FPL HIV+ under 65 with income up to 133% FPL (133- 200% still in Family Assistance) Former foster children up to age 26 regardless of income Adults up to 133% FPL eligible for DMH services or determined “medically frail” & choose Standard over CarePlus 18

19. Improvements for Children in Family Assistance Family assistance for children 150-300% FPL – Children 200-300% FPL no longer have to be uninsured for prior 6 mo. – Premium Assistance now available for children 200-300% FPL enrolled in a parent’s employer- based insurance at time of application – Children who lose coverage for nonpayment of premiums can re-enroll after 90 days even if back premiums are not paid 19

20.  Adults 21-64 with income under 133% FPL & not eligible for Standard as pregnant, disabled or parents & not on Medicare  MassHealth CarePlus unless “Special Health Care Needs” (also called “Medically Frail”) & choose MH Standard MassHealth CarePlus-NEW 20

21. MassHealth CarePlus Differences from Essential or Comm. Care No eligibility restrictions based on – Employment, college attendance, access to other insurance Premium assistance with CarePlus secondary is available (if cost effective) Medical coverage 10 days prior to application-Fee for Service; MCO begins first of month after eligibility Better benefits including non-emergency transportation No Primary Care Clinician-Partnership option; only MCOs 21

22.  Medically Frail must be given the option to enroll in either CarePlus or Standard  Remain in CarePlus until they affirmatively seek MassHealth Standard – Standard will begin right away after selection  Allowed to enroll in PCC Plan with access to the Partnership Behavioral Health providers or MCO & MH Standard benefits  Don’t confuse with “frail elder waiver” Special Health Care Needs /Medically Frail

23. MassHealth MCOs Standard, CommonHealth & Family Assistance – BMC Health Net – Tufts Network Health – Neighborhood Health Plan – Fallon Health Plan – Health New England CarePlus – BMC Health Net – Tufts Network Health – Neighborhood Health Plan – Fallon Health Plan – Health New England – CeltiCare

24. MassHealth Small Business Employee Premium Assistance (new): Have not enrolled in your employer’s insurance in the six months before the date of application Adults ages 19-20 with income above 150% and at or below 300% FPL and those 21-64 with income above 133% and at or below 300% FPL who: Work for a small employer with 50 or fewer employees Have access to employer-sponsored health insurance that precludes them from receiving Premium Tax Credits through the Health Connector but is not affordable to them according to Health Connector Affordability Schedule Max. $150 PMPM premium assistance for up to 2 adults to enroll in employer’s insurance Minimum premium contribution same as ConnectorCare 24

25. 6 ConnectorCare Framework & Summary  The ConnectorCare program has been designed to replicate the Commonwealth Care program, including its benefits, premiums and cost-sharing, as well as carrier and provider choices  The Commonwealth is using state dollars (with some Federal match) added to the ACA tax credits and subsidies for the population earning up to 300% FPL that is eligible for coverage through the Health Connector

26. ConnectorCare Program Who can qualify for a ConnectorCare Plan? Individuals or families living in Massachusetts with incomes at or below 300% of the Federal Poverty Level (FPL) may qualify for ConnectorCare. If you and your family qualify, your Plan Type will depend on your household income. Those with incomes above 300% FPL cannot qualify for a ConnectorCare plan, but may qualify for tax credits that help to lower the cost of insurance if they have income up to 400% FPL More on ConnectorCare this afternoon with Suzanne

27. Process changes: Provisional Eligibility NEW: MassHealth will provide a 90-day post eligibility verification period, termed a “provisional eligibility” period. Similar process in Connector is called “inconsistency period.” Self-attestation will be accepted for all eligibility factors except for disability status. If MassHealth is unable to verify self-attested eligibility factors through federal and state data hubs, or if the information provided by an applicant is not reasonably compatible with the information available through the data hubs, MassHealth will require verification from the individual post eligibility determination. Necessary verifications will be required within 90 days of the eligibility determination in order to maintain enrollment. The Citizenship and Immigration Reasonable Opportunity Period will also be aligned for 90 days. Only one Provisional Eligibility Period in a 12 month period. No Premium Assistance during Provisional Eligibility Period 27

28. Hospital Determined Presumptive Eligibility A qualified hospital may make presumptive eligibility determinations for its patients. Presumptive eligibility will be determined based on self-declared information. Categories of Hospital Presumptive Eligibility: 1.MassHealth Standard: for children under age 19;for young adults aged 19 or 20; pregnant women; parents or caretaker relatives; individuals with breast or cervical cancer; individuals who are HIV positive; or independent foster care children up to age 26 2.MassHealth CarePlus for adults aged 21-64 3.MassHealth Family Assistance, if the individuals meet the categorical and financial requirements of MassHealth Family Assistance and are HIV positive, or children who have a nonqualified PRUCOL immigration status Note: MassHealth will not charge a premium during the hospital presumptive period. There is no Premium Assistance available during presumptive eligibility. 28

29. MassHealth Redetermination/Renewal Suspended since Oct 2013 but starting up again soon New process – Expanded use of SNAP data for automatic renewal – Renewal through data matches if possible – Prepopulated form If terminated for not returning form, 90 day grace period to return form & be reinstated with no gap in coverage 29