Implementing Federal Health Reform in Massachusetts. Stakeholder Meeting December 16, 2010. Agenda. Welcome Exchange Planning Employer Forum Review and Feedback Long-Term Care and Behavioral Health Opportunities Update Stakeholder Engagement Questions and Discussion. Exchange Planning.
December 16, 2010
Employer Forum Review and Feedback
Long-Term Care and Behavioral Health Opportunities Update
Questions and Discussion
Exchange Transition Planning Program
Connector Board and Stakeholder Engagement
Policy & Legal Workgroup
Information Technology/ Business Operations Workgroup
Product Assessment & Development Workgroup
Small Business Workgroup
Workgroups to be supported by appropriate consultant-based assistance, as necessary
At about 500%FPL, the Massachusetts Affordability Schedule defines coverage as “affordable.”
Health Insurance Exchange
Subsidized Individuals & Families (133%-400% FPL)
Insurance Carrier 1
Unsubsidized Individuals & Families (>400% FPL)
Insurance Carrier 2
Insurance Carrier 3
Insurance Carrier “N”
Paper – MBRs
Online - portal
While the Health Connector will be planning for transitioning to an Exchange compliant with federal requirements come 2014, it will also be hard at work maintaining and improving existing programs for consumers and small businesses . . .
Recap of Employer Forums on Federal Health Reform
Commissioner David Morales
Division of Health Care Finance and Policy
How These Forums Came About:
Employer Work Group identified employer outreach and education as key goal for 2010
Planned a series of seven forums from Pittsfield to Cape Cod from late October through early December
Forums were in partnership with AIM and a host of other employer associations and local Chambers
Goal was to prepare employers for upcoming changes by:
Summarizing employer provisions in PPACA
Briefing employers on differences between national health reform and Massachusetts health reform
Actively seeking feedback from employer community to streamline processes
Establishing a two-way line of communication between Commonwealth and employers regarding health reform
Executive Office of Health and Human Services (EOHHS)
Division of Health Care Finance and Policy (DHCFP)
Division of Unemployment Assistance (DUA)
Division of Insurance (DOI)
The Health Connector
Department of Revenue (DOR)
Office of Small Business and Entrepreneurship (OSBE)
Administration and Finance (ANF)
Immediate/Awaiting Regulatory Guidance:
Small Business Tax Credits
Reinsurance for early retiree health care costs
Grants for Small Employer Wellness Programs
Reasonable Break Time and Space for Nursing Mothers
Automatic ESI enrollment for employees at very large firms (200+ workers)
Changes to Health Savings Accounts, Flexible Spending Accounts, Etc.
Employer Notifications to Employees
Elimination of Deduction for Medicare Part D Expenses
Medicare Payroll Tax
Changes to Section 125 Plan rules
Free Choice Vouchers
Excise Tax on High Cost Health Plans
Comparison of Current Massachusetts Fair Share Contribution Policy and PPACA’s Employer Assessment (effective in 2014)
What to do with 11-50 FTE size category
What to do with 50+ FTE firms that could potentially be liable for both state and federal assessment
Differing definitions around terms like full-time worker, full-time equivalent employee, and appropriate waiting periods
There are issues for both employers and the Commonwealth at stake.
The Administration recognizes that these decisions will have an impact on how businesses make benefits decisions and plan ahead.
These decisions will have a fiscal impact on Commonwealth because Fair Share Contributions are used to finance Commonwealth Care.
The Administration is also reviewing Massachusetts’ policies related to the Section 125 plan requirement, Free Rider Surcharge, and the Employer/Employee HIRDs to determine if they need to be revised.
The Section 125 requirement requires that all employers with 11 or more FTEs offer a Section 125 plan (or a “Cafeteria Plan”). A Section 125 plan allows employees to pay their health insurance premiums using pre-tax wages.
Free Rider Surcharge assesses employers that do not have a Section 125 plan in place, but whose employees (or their dependents) exceed the set cost threshold of state-funded health care.
The new federal health reform law does not allow employees to buy individual policies of health insurance through an exchange on a pre-tax basis using a Section 125 plan.
This appears to be at odds with current Massachusetts law which requires employers with 11 or more full-time-equivalent employees to establish Section 125 plans.
The Administration is seeking clarification from the federal government on how this area of the law will interact with Massachusetts’ law.
Currently, employers are required to collect Employee Health Insurance Responsibility Disclosure (HIRD) forms from all workers that turn down offers of ESI (Employer Sponsored Insurance) or Section 125 plan participation.
The Employer HIRD is collected annually from most employers and quarterly from a small portion. The form asks whether employers are maintaining a Section 125 plan, offering insurance, cost of premiums, etc.
The PPACA law indicates that HHS will have the authority to collect similar information starting in 2014, but any federal Employer HIRD-like form will not be inherently tied to the Free Rider Surcharge assessment determination.
Changes to Massachusetts Health Reform employer policies (e.g., Fair Share and Free Rider, etc.) will likely require both statutory and regulatory changes
Statutory changes are made by the state legislature
Regulatory changes are made by state agencies in the Executive Branch of state government
Employers need to be engaged, informed and active
Employer based system means employers pay!
State agencies and legislators want to hear from employers
Policy makers must hear from you as they develop policies that will affect your business.
Your voice matters!
The Commonwealth is actively seeking employer feedback as it works to design a way to align state and national law
How should employers make their voices heard?
Educate yourselves and your employees on the new law
Visit our website to stay up to date: www.mass.gov/nationalhealthreform
Contact relevant state agencies to exchange information
Partner with trade and advocacy organizations
Engage with your state legislators on how the new law impacts you
Expanding Community-based Care Services Options for elders & people with disabilities
Improving Access to Care & Care Management for People with Disabilities
Improving Care Access, Management & Financing for People with Disabilities
Total grants awarded: $13,258,000.00