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Overview of the Massachusetts Health Connector and Health Care Reform Initiatives

This document provides a comprehensive recap of the Massachusetts Health Care Reform of 2006, including key elements such as Medicaid Expansion and creation of the Connector as an independent state agency. Led by Deborah C. Enos, President and CEO of Neighborhood Health Plan, the Connector oversees Commonwealth Care (for subsidized insurance) and Commonwealth Choice (for commercial plans). It administers policy decisions, outreach, and conducts advertising campaigns. The presentation details governance, operations, and the Connector's role in providing affordable health insurance options to Massachusetts residents.

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Overview of the Massachusetts Health Connector and Health Care Reform Initiatives

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Presentation Transcript

  1. Life with The Connector Massachusetts Health Insurance Exchange Deborah C. Enos President and CEO, Neighborhood Health Plan ACAP CEO Summit | July 13, 2010

  2. Recap of Massachusetts Health Care Reform (2006) • Medicaid Expansion • Commonwealth Care (subsidized) • Commonwealth Choice (commercial) • Individual Mandate • Employer Responsibilities • Insurance Reforms

  3. What is the Connector? An Independent State Agency • Connector Board • Executive & AdministrativeStaff

  4. What is the Connector? The Board: 10 Members • 4 Ex Officio • Secretary A & F • Medicaid Director • 1 Actuary • 1 Economist • 1 Health Policy • 3 Employer/Labor • Commissioner of Insurance • Executive DirectorGroup Insurance Commission Administration: Executive Director & Staff

  5. Connector Board • “Open/Closed” Meetings • Schedule • Interaction with Plans • Sub-committees • Policy • Outreach

  6. What does the Connector do? • Makes Policy Decisions (per Ch. 58) • Conducts Outreach/Advertising • Operates Two Exchanges • Commonwealth Care • Commonwealth Choice

  7. Policy Decisions • Minimum Creditable Coverage • Plan Design (Benefits & Premiums) • Affordability Standards • Mandate Waivers • MCO Approval (“Seal of Approval”) • Insurance Risk Oversight • Distribution Channels

  8. Advertising and Outreach • Public Campaign (Red Sox) • Website: MAHealthConnector.org • Community Grants • Health Plans

  9. The Connector: “Two Exchanges in One” Commonwealth Care5 MCOs Subsidized Commonwealth Choice7 MCOs Commercial, Non-Group, Small-Group (Standard Benefits; Administration) “Medicaid”- Like (Standard Benefits; Administration) “Intermediary”- Like Eligibility Enrollment Premium Billing Customer Service Appeals

  10. Exchange Design Considerations • Active vs. Passive Role • Medicaid vs. Commercial Framework • Governance Authority • Experience of Leadership • Involvement of Stakeholders • Transparency • Evaluation & Monitoring

  11. Thank you

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