Implementation of health care coverage programs began recently in Massachusetts, Florida, and Maryland. These changes, in place since the beginning of July, are being phased in slowly and can serve as models for other states considering various coverage strategies.
Massachusetts: Although the June St@teside discussed the individual and employer components of the new Massachusetts health plan, the reform also includes a strategy for limited Medicaid expansions to new populations. First, between 27,000 and 40,000 children in Massachusetts who had either limited health coverage or none at all became eligible for subsidized insurance when the state implemented the first provisions of the health plan July 1. The reform legislation increased the qualifying income requirement from 200 to 300 percent of the federal poverty level for children to be eligible for state’s SCHIP program. In addition, benefits in MassHealth plan that had been cut in 2002 were restored including vision, dental, and chiropractic services as well as coverage for prosthetics. Massachusetts is working to implement other components of its new law over the next few years.
Florida: Like Massachusetts, Florida has opted to expand their Medicaid program to cover more uninsured. The program expansion was launched in Duval and Broward counties on July 1 and will extend to Nassau, Clay, and Baker counties after one year—with a goal of eventual state-wide service. In addition to offering more choices for beneficiaries, including customized benefit packages and an “opt out” option where beneficiaries may choose to use their allocation to purchase insurance through their employer, the expansion also features risk-adjusted rates and program choice counseling.
Maryland: The Primary Adult Care Program (PAC) was implemented on July 1 and will offer health care services to low-income individuals (incomes less than 116% of poverty) who are over 19 years old and not eligible for Medicare. The program was approved as an amendment to Maryland’s managed care Section 1115 waiver and replaces the Maryland Pharmacy Assistance Program and the Maryland PrimaryCare Program. The PAC program is designed to prevent and treat health problems in a primary care setting and covers physician office visits, prescription drugs, outpatient mental health visits, and some limited additional services. Hospital, emergency room, and specialty care services are not covered. PAC enrollees will access most of their care through Medicaid managed care organizations. The Maryland Department of Health and Mental Hygiene estimates that PAC will cover approximately 30,000 adults in fiscal year 2007.
For more information on the health coverage profiles of these three states—and more—visit the Coverage Matrix on the SCI website.
