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Commonwealth Care &
Commonwealth Choice
MTF Presentations April 2012
Agenda
• Commonwealth Care Bridge &
Aliens with Special Status (AWSS)
• Commonwealth Care: – Open Enrollment 2012
• Commonwealth Choice:
– Non-Group Residency Verification – Non-Group SSN requirement elimination
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Recent Supreme Judicial Court Decision
• As a result of a recent decision by the Supreme Judicial Court, Aliens with Special Status (AWSS) will be re-integrated into the Commonwealth Care health insurance program run by the State’s Health Connector.
• In this presentation, we will review integration plans for – Former Bridge members – AWSS on the waiting list – Newly eligible AWSS individuals
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When and how did this happen?
For Former Commonwealth Care Bridge Members • Effective March 1, 2012, all former Bridge members were enrolled
in Commonwealth Care.
• During the month of February, members received customized information that explained their options in more detail. If they were eligible and wanted to change health plans, they were able to do so by phone, mail or fax, from February 13–24. Current Commonwealth Care program rules applied, i.e. Plan Type 1 members were able to choose from the Lowest Cost Plans in their Service Areas, if there is more than one available.*
• If a member wanted to remain in their current health plan, they did not need to do anything.*
*Certain former Bridge members in the Pittsfield service have been reassigned to a new health plan. This occurred if a member’s current health plan was no longer available in the service area or if they failed to choose a new health plan.
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How were members informed?
During the week of February 6th, members received a customized enrollment packet that included:
• MCO options and premium costs, if applicable
• Benefits and copayment chart
• Hospital grid by MCO
• MCO inserts (informational flyers)
• Babel sheet
Please note: Eligibility representatives (ERDs) also received a separate mailing that notified them of the recent changes for the AWSS population and the special selection period for Bridge members.
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How did costs and health benefits change for former Bridge members?
• If members were required to pay a monthly premium, that amount may be different, depending on which health plan they chose.
• The co-payments for some covered services are different in the Commonwealth Care program.
• In addition to the benefits members currently receive, they now have access to: – Preventive Dental (Plan Type 1 members only) – Vision benefits – Skilled nursing services – Hospice care
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How will enrollment work for newly eligible or waiting list AWSS individuals?
• After August of 2009, any AWSS who was determined eligible for Commonwealth Care was placed on a waiting list for the Bridge program.
• In late March and April 2012, AWSS currently on the waiting list who are still eligible and any newly eligible AWSS will be notified by mail. Those who enroll immediately, may be eligible for Commonwealth Care with an effective date as early as May 1st.
• An additional, separate multi-lingual mailing will follow each MA21 eligibility letter. (more detail on the following slide)
• Eligible individuals will be able to enroll in Commonwealth Care via the member portal or by calling the member service center.
• FY12 Commonwealth Care program rules will apply to former Bridge members and AWSS populations. 7
Multi-lingual mailing
• Immediately following their eligibility letter, individuals will receive a special multi-lingual mailing from the Health Connector.
• Message: Good news! You recently received a letter that says you are now eligible for Commonwealth Care health insurance. You must sign up in order to start your health benefits. Sign up online at MAhealthconnector.org or call 1-877-623-6765 (TTY 1-877-623-7773 for people with partial or total hearing loss). If you have to pay a premium, it must be received by the 25th of the month to start your health insurance on the 1st of the next month.
• Translated languages: English, Spanish, Traditional Chinese,
Simplified Chinese, Brazilian Portuguese, Haitian Creole, Vietnamese, Kmher (Cambodian)
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How can newly eligible or waiting list AWSS individuals enroll in a health plan?
Once an eligible individual receives their eligibility letter from MassHealth (MA21 notification) there are two ways to complete enrollment.
• Web: Online at MAhealthconnector.org
• Phone: Call the Commonwealth Care Member Service Center 1-877 MA ENROLL (1-877-623-6765) or TTY 1-877-623-7773 for people with partial or total hearing loss
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How does Open Enrollment apply to former Bridge members or newly enrolled AWSS individuals? • The Commonwealth Care annual Open Enrollment is
scheduled for June 2012. – All Commonwealth Care members enrolled with an effective
date of June 1, 2012 or prior, including former Bridge Members and other newly enrolled AWSS members, will be able to switch to any available health plan in their service area for any reason during Open Enrollment.
• On July 1, 2012, Commonwealth Care Program rules may
change as a part of the new year (FY13). These program rules will apply to all new members throughout the new year.
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Commonwealth Care: Open Enrollment
FY2013 Challenge
• Commonwealth Care is faced with major fiscal challenges in FY13 due to significant increases in anticipated enrollment
– As a result of the Finch case, we are anticipating 34,000 AWSS members covered under Commonwealth Care in FY13
– Growth is also expected as a result of membership transition from the Medical Security Program (MSP) when the current Unemployment Insurance (UI) extensions phase out
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Procurement Strategy
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1. The bid ceiling (Medical + Administration) was set at $415 PMPM
2. (New) Bidders could bid below the preliminary actuarially sound rate floor, subject to independent actuarial review and certification
3. Enrollee premium differentials set based on bid position
4. A subset of incoming Plan Type I members would have limited choice of the low-cost MCO(s) available in their service areas, including the lowest-cost MCO and the 2nd-lowest-cost MCO, provided that the 2nd–lowest-cost MCO bids no higher than $380 PMPM
5. An active open enrollment for Plan Type I members would be triggered if less than two current statewide Commonwealth Care MCOs bid at or below $380 PMPM
Thus, our FY13 procurement strategy pursued the same basic framework as in FY12, with certain refinements:
Summary of FY13 Bid Results
• We project that FY13 will achieve another 5% decrease in aggregate capitation rates relative to FY12
• Majority of plans proposed a rate cut for FY13, and every single plan now has rates lower than those from FY11 (two years ago!)
• No cuts in benefits, no increases in copays; “spread” between the lowest and highest enrollee premiums per income category is narrower than last year
• No major changes to health plan provider networks
• Existing members have the full choice of health plans during open enrollment
• All incoming members have at least two health plans to choose from encompassing a broad array of hospitals and doctors
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Capitation Bids
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Most MCOs bid flat or lower rates relative to FY12.
Medical + Administrative Capitation Bid, $PMPM
$415.00
$354.58
Preliminary Bidding Range
$414.95
$346.30
BMCHP Fallon
Community Health Plan
Neighborhood Health Plan
Network Health CeltiCare
FY11 FY12 FY13
$415.00
$377.00
$354.47
All five capitation rate bids have been determined by an independent actuary to be actuarially sound and are within the final actuarially sound rate range.
Provider Networks
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• All MCOs have proposed either the same or expanded networks compared with FY12
• Network Health’s FY13 network will include the addition of Mass Eye & Ear Infirmary, effective February 2012, and Signature Healthcare and Sturdy Memorial Hospital, effective July 2012
• The two lowest bidders – BMCHP and Network Health – collectively cover 66 out of the 73 acute hospitals in the state
Plan Type I Enrollment Rules
• Incoming Plan Type I members without prior coverage history in another available MCO through either Commonwealth Care or MassHealth in the past six months will be required to choose between the two “low-cost MCOs” in their Service Area
– All other incoming Plan Type I members will have a choice of all MCOs
• In 35 out of the 38 Service Areas, the low-cost MCOs will be BMCHP and Network Health
– In the Greenfield Service Area, the low-cost MCOs will be BMCHP and CeltiCare
– In the Oak Bluffs and Nantucket Service Areas, the low-cost MCOs will be Network Health and CeltiCare
• There will not be an Active Open Enrollment for Plan Type I members in FY13
– Three current statewide Commonwealth Care MCOs (BMCHP, Network Health and CeltiCare) bid below the $380 PMPM threshold
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FY13 Enrollee Premium Recommendation
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Base Enrollee Premium BMCHP
Network Health CeltiCare
Neighbor-hood Fallon
FY12 PT IIA $0 $34 $0 $0 $21 $27
PT IIB $39 $91 $39 $39 $72 $80
PT IIIA $77 $152 $77 $77 $125 $137
PT IIIB $116 $197 $116 $116 $167 $181
FY13 PT IIA $0 $0 $3 $12 $28 $28
PT IIB $40 $40 $45 $58 $81 $81
PT IIIA $78 $78 $85 $105 $138 $138
PT IIIB $118 $118 $126 $147 $182 $182
Change PT IIA $0 ($34) $3 $12 $7 $1
(From FY12 to FY13) PT IIB $1 ($51) $6 $19 $9 $1
PT IIIA $1 ($74) $8 $28 $13 $1
PT IIIB $2 ($79) $10 $31 $15 $1
Note: this summary reflects the premium schedule of 36 Service Areas. Modifications apply to 2 Service Areas.
21%
56%
19%
4%
Enrollee Premium Impact
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% of PTs II & III members with premium change
(based on current membership distribution)
Maximum premium spread is slightly narrower compared with FY12
Based on current membership distribution, average FY13 enrollee premium will decrease relative to FY12
Because members have the option to switch to lower premium health plans during open enrollment, actual average enrollee premiums in FY13 may be even lower
Decrease $34 ~ $79
Increase $10 ~ $20
Increase up to $10
Increase >$20
FY12 FY13
PT IIA $12 $10
PT IIB $59 $55
PT IIIA $106 $102
PT IIIB $148 $142
Member Communications – Letters – Web & Emails – Open Enrollment materials
Call Center support Stakeholder communication & training for member support
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Open Enrollment Operational Readiness
In preparation for FY13 Open Enrollment, we plan to leverage feedback from the Year 2 member survey to improve communications, benefit materials and customer support.
Key Messages for Members 1. Inform members that open enrollment is the annual
opportunity to change health plans for any reason – Time period: June 1st – 22nd
2. Use ‘call to action’ message: – “Do you want to change your health insurance plan?
Now is the time.*“
3. Important considerations for the member – Your monthly premium may be increasing or decreasing
– The providers (such as doctors and hospitals) that are available from each health plan’s network may vary
– Your benefits and copays will be the same, no matter which health plan you choose
4. Ensure new Commonwealth Care members (AWSS and others) are aware of and familiar with the Open Enrollment period
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* During other times of the year, you are only allowed to make a health plan change if you meet a qualifying event as
described in the Commonwealth Care program guide
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Letters Packets Web page -Premium Comparison -Plans by region -Decision support tool -Benefits and Copays -Hospital list by MCO -Community Health Center by MCO -Enrollment Tutorial
Emails Invoice Text & Insert
May 2012 June 2012 July 2012
Last week in May PACKET Mailed to those enrolled by May
First week in June PACKET Mailed to those enrolled for June
PRE OPEN ENROLLMENT LETTER Letters to non premium paying members ( 0 -150%) Mid May
WEBPAGE posted Mid - May
EMAIL sent with link to web page
Reminder EMAIL sent
June 1st – 22nd Open Enrollment
INSERT and INVOICE TEXT included in May Invoice
INVOICE TEXT included in June Invoice
Member Communications
Call Center Support
Open enrollment is the busiest time of year for the call center. Last year during Open Enrollment, 69% of members who made a change did so over the phone. Given this, and the feedback from the member survey on the importance of customer service, it is critical that members get the support they need.
• Methods for making a change (Online, Phone, Mail)
• Increase staffing levels to ensure service levels are met and calls are answered promptly
• More robust call center training
– Focus on new FY13 program changes and welcoming new members
– Soft skills – focus on empathy, courtesy and respect
– Prepare team for inquiries after Open Enrollment
• Simplified IVR (fewer automated messages)
• Ongoing calibration sessions before, during and after Open Enrollment
– Ensure quality monitoring is aligned with training, supervision & call handling
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Stakeholder Training & Communications April – June
• State-wide Massachusetts Health Care Training Forums (MTF)
– April 18th and 20th
• Open enrollment conference calls for hospitals, health centers, MCOs and Advocates
– April 24th and April 26th
• Advocate meetings
– April 13th , May 11th, June 8th
• MCO collaboration
– April 13th and on-going follow-up as needed
• Web resources posted on www.MAhealthconnector.org
• Email reminders to these stakeholders via listserv
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FY13 Commonwealth Care Contract Recommendation
Connector staff recommends that FY13 Commonwealth Care contracts be awarded to the following health plans, contingent upon final agreement on contracts, for the period beginning July 1, 2012 and ending June 30, 2013:
BMC HealthNet Plan CeltiCare Health Plan Fallon Community Health Plan Neighborhood Health Plan Network Health
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Commonwealth Choice: Non-Group Residency Verification
Non Group Residency Verification – Starting April 1, 2012 coverage date
In an effort to strengthen eligibility policy whereby an applicant for non group insurance must be a Massachusetts resident the Connector may require that an applicant provide reasonable documentation to verify residency. Pre-Enrollment • The Connector’s implementing a pre-enrollment screening to ensure
Massachusetts residency. • The process of completing an enrollment application will include:
– A screening process validating a number of key personal identifiers used to determine prospects eligibility; only flag enrollments according to screening
– The collection of paper documentation to prove eligibility (residency). Standards on upcoming slide.
– Applicant deadline to submit documentation is five (5) business days before the requested effective coverage date (for example, March 26th for April 1st coverage date)
Post-Enrollment Eligibility Verification – Renewals: Carriers may choose to conduct MA residency
audits for all renewing members, including those from the Connector. Carriers must notify members 120 days prior to renewal of residency audit.
– For members terminated or not renewed, members will be given a 90-day reconsideration period commencing on the last date of coverage, during which time the member may submit the required documentation and, if s/he does so and pays outstanding premium(s), will be retroactively enrolled to the last date of coverage.
– Reinstatement of coverage: members who are terminated/non renewed for failure of proof will have the ability to seek reinstatement retroactive to the termination date.
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Non Group Residency Verification – Starting April 1, 2012 coverage date (contd.)
Proof of Residency Standards To determine MA residency, the Connector will require individuals to submit the following documents(one from each column). If an individual is unable to supply this specific documentation, the Connector may consider other reasonably similar forms of proof of residency. This list could change over time to remain consistent with DOI regulations.
Column A Column B
Copy of deed and record of most recent mortgage payment (if mortgage is paid in full, provide a copy of property tax bill from the most recent year)
Valid MA driver’s license or MA photo identification card
Copy of lease AND record of most recent rent payment Current MA vehicle registration
Notarized legal affidavit from landlord confirming residency AND record of most recent rent payment;
Excise (vehicle) tax bill
Section 8 agreement Massachusetts tax return (dated within the last year)
Home Owner’s Insurance agreement Most recent payroll stub; or
A utility bill or work order dated within the past 60 days for: •Gas •Oil •Electric bill •Cable bill
Receipt of in-state tuition for self or custodial dependent
Proof of enrollment of custodial dependent in public school
Receipt or public assistance for self or custodial dependent
W-2 form (dated within the last year)
Commonwealth Choice: SSN Requirement Change
SSN Requirement Change: SSN is now optional when applying for Individual & Family health insurance
• Effective March, the Heath Connector no longer requires Social Security Number (SSN) as a part of the insurance application for individuals and families. * Applicants have the option to include the SSN information if they choose.
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*DOI Bulletin 2011-19
SSN Requirement Change: Currently in Production
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SSN Requirement Change: Currently in Production
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Subscriber SSN field change
Upcoming presentations and communications
• Commonwealth Care Open Enrollment details – Conference calls week of April 23rd
• 2012 Commonwealth Care Member Survey
information – Visit MAhealthconnector.org to view complete board
presentation
• Details on Commonwealth Choice Individual Open
Enrollment Period – July 1 – August 15th
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Contact Information
Contact Info: Commonwealth Care
Commonwealth Care Member Service Center Monday - Friday from 8:00 a.m. to 5:00 p.m. at
1-877-MA-ENROLL (1-877-623-6765). TTY: 1-877-623-7773 for people with partial or total hearing
loss
or visit us online MAhealthconnector.org
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Contact Info: CommChoice
Commonwealth Choice Member Service Center Monday - Friday from 8:30 a.m. to 5:00 p.m. at
Phone: 1-866-636-4654 Fax: 508-770-0167
TTY: 1-888-213-8163 for people with partial or total hearing loss
or visit us online www.MAhealthconnector.org
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