We have achieved historically low enrollment growth due to fixing eligibility system defects and enhancing eligibility controls Annual enrollment growth 3-4% 42%* –7.7% +1% +1.6% Annual enrollment growth 2007-2014 (pre-ACA) Without reform package: 2.2-3%** * ACA Medicaid expansion + Temporary Medicaid due to failed HIX ** Approximate range of caseload growth in conference budget; high end of range reflects exposures built into budget
MassHealth spending has been reduced from historical double-digit annual growth to single-digits, but reforms are required for sustainable growth MassHealth Program Spending $ billions Gross Program Spend Net State Cost 15.6 FY13-15 CAGR FY16 FY17 FY18 GAA 5.0% w/o package 9.2 10.3 10.7 11.8 13.5 14.6 15.0 5.1% 8.5% 2.7% 3.7% w/ $47M in 3.1 3.5 4.7 5.0 5.4 5.9 6.1 6.0 6.1 net growth due to management initiatives, including: $30M in increased Rx rebates $73.5M one-time DSRIP revenue FY10 FY12* FY13 FY14 FY15 FY16 FY17 FY18 GAA - $25M in higher CHIP revenue %
In order to implement major pieces of the Reform Package in January 2019, state and federal authority must be final by end of 2017 2017 2018 2019 Public comment (July/August) Legislative hearings State + federal approvals Shift non-disabled March: CCA releases RFR for 2019 plan year 1/1/19: 140,000 adults (21-64) 1/1/18: details finalized and July: CCA carrier rates Nov: CCA open adults shift to Connector communicated to health plans/ carriers due Jan-Sep: HIX/ enrollment system logic + coding Summer: member communications to prepare for open enrollment ESI gate, pharmacy changes, employer reporting for premium assistance Modernized Health Connector Business Platform launches
Non-disabled adults (ages 21-64) coverage: 650,000 lives Under 100% FPL 100-138% FPL Childless Adults Parents and Remain in MassHealth CarePlus (~280,000) Move from MassHealth Standard to MassHealth CarePlus (~230,000) Transition to Connector from MassHealth CarePlus (~40,000) Move from MassHealth Standard to Health Connector plan (~100,000) Similar to Ch. 58 (covered on Connector) If disabled or medically frail, remain in MassHealth Standard ~510,000 ~140,000 | 15
MassHealth coverage types* Population (today) Covered Services Notes ~1.2M members Kids <150% FPL Pregnant women and infants <200% FPL Parents/Caretakers <133% FPL Disabled and medically frail adults** <133% FPL Seniors <100% FPL ~320K members “ACA expansion” population of childless, non-disabled adults 21- 64 ~185K members Lawfully present adults <133% FPL Individuals not lawfully present who would otherwise qualify for Standard or CarePlus but for Full MassHealth benefit, including medical, dental, behavioral health, long- term services and supports, and medical transportation Same benefits as Standard except does not cover LTSS because population is not disabled Emergency services only Under reform proposal, non- disabled parents/caretakers <100% FPL will move to CarePlus, and parents/caretakers 100-133% FPL will move to ConnectorCare Under pending 1115 waiver request, CarePlus will not cover non-emergency medical transportation (except for substance use treatment) Lawfully present individuals are also eligible for ConnectorCare ~25K members Members with employer or student health insurance MassHealth assists with premiums and cost sharing Commercial/primary insurance benefits + MassHealth “wrap” (e.g., dental services) Premium assistance is mandatory for adults when cost effective for MassHealth *Not comprehensive (e.g., does not include Family Assistance for kids up to 300% FPL, CommonHealth for higher income disabled kids and adults)