Rosemarie DayDeputy Director and Chief

Operating OfficerCommonwealth Health Insurance

Connector Authority

State Coverage Initiatives National Meeting

Nashville, Tennessee

Thursday, February 7, 2008

Organizing Health ReformEarly Lessons from Massachusetts

Residents:▪ Individual mandate

Government:▪ Connector▪ Regs & oversight▪ Premium assistance

Employers: ▪ Make "fair" contribution▪ Set up Section 125

Key element of MA Health Care ReformShare the responsibility

Government’s RoleMultiple State Agencies Involved

Health ConnectorOrganization

Health Connector was established by the law as an independent public authority overseen by a board of ten directors.

Many key policy decisions left to Connector Board

Organization was free from some state agency constraints (e.g. hiring, procurement).

Launch and administer Commonwealth Care program Launch and administer Commonwealth Choice program Define minimum creditable coverage

Establish Affordability standards

Promulgate regulations on S. 125 Plan requirement for Mass employers

Administer waivers and appeals related to the individual mandate

Health ConnectorKey Tasks

Health ConnectorRapid Ramp-up

Law passed April 2006.

Executive Director was hired in June 2006.

First Board meeting was held on June 7, 2006.

Core staff was hired during the summer and fall of 2006.

CommCare implemented October 1, 2006.

CommChoice implemented May 1, 2007.

Health ConnectorStrategic Outsourcing

Young Adults Small Biz. Voluntary Plans Indiv.& Families

Health ConnectorRole in insurance market

Health ConnectorState-of-the-art Website

ResultsBroadened Access (as of 1/1/08)

Net new commercial insurance 100,000(includes almost 16,000 with coverage through Commonwealth Choice)

Commonwealth Care ~170,000

Medicaid enrollment growth 70,000

________

TOTAL > 300,000

Enrollment (000's) as of the first of the month

0

60

120

180

Feb '07 Mar '07 Apr '07 May '07 J un '07 J ul '07 Aug '07 Sep '07 Oct '07 Nov '07 Dec '07 J an '08

P remium paying

No premium

As of 1/1: 168,924 members- 42,114 premium paying- 126,810 no premium

ResultsSteady Growth in Commonwealth Care

Members (subscribers and dependents)

15,938

8,306

5,095

2,799

7,241

10,199

14,350

0

6,000

12,000

18,000

J ul '07 Aug '07 Sep '07 Oct '07 Nov '07 Dec '07 J an '08

ResultsSteady Growth in Commonwealth Choice

Overall, implementation has been helped by:

– Tight deadlines

– Continued stakeholder support

– Flexibility in the law

– Board of Directors

– Partnerships with existing state agencies

– Sufficient start-up funds

Health ConnectorImplementation Lessons

Specifically, Commonwealth Care implementation was facilitated by:

– Existing MassHealth infrastructure

– Uncompensated Care Pool “members”

– Auto-assignment

– Virtual Gateway infrastructure

– Outreach grants

Health ConnectorImplementation Lessons

Be a “virtual organization” (buy, don’t build)

Take incremental steps (“walk before run”)

Over-prepare for every Board meeting

Be a “learning organization”

Health ConnectorOverall Lessons