On October 2, 2006, the Commonwealth of Massachusetts began the first phase of implementation of its new health care reforms. Adults who earn up to 100 percent of the federal poverty level (FPL) and are uninsured are now eligible for a new insurance product, the Commonwealth Care Health Insurance Program (Commonwealth Care), which is administered by the Commonwealth Health Insurance Connector Authority (the Connector).
Phase one of Commonwealth Care targets non-MassHealth (the state’s Medicaid program) eligible adults who currently receive free care from the Uncompensated Care Pool. Individuals deemed eligible will receive an enrollment packet and the member will be able to select one of four health plans. If the individual does not select a health plan after fourteen days, the Connector will auto-enroll the member in a health plan. Members will then have up to sixty days after they have been enrolled to switch health plans.
Benefits in the Commonwealth Care product include inpatient hospital services, outpatient and preventative services, inpatient and outpatient mental health and substance abuse services, dental and vision care, and prescription drugs. At this income bracket, there are no monthly premiums but members are responsible for co-payments for generic and brand-name drugs ($1 and $3 respectively) and emergency room use that does not result in an inpatient admission ($3). There is an annual member out-of-pocket maximum for prescription drugs of $200.
The Connector will implement phase two of Commonwealth Care in January 2007. The next phase will provide health insurance benefits to people who earn between 100.1 percent FPL and 300 percent FPL. Connector premiums will vary by income level and by health plan. The state has set a sliding scale subsidy and member premiums will range from a low of $18 for individuals with annual income between 100.1% FPL and 150% FPL, to a high of $106 for individuals with annual income between 250% FPL and 300% FPL.
The benefits package for this group of eligible individuals includes co-payments for most services, with out-of-pocket maximums ranging from $500 to $750, depending on the plan selected and the income category of the individual.
Children of parents eligible for Commonwealth Care are covered through a separate Medicaid program administered by MassHealth.
The Commonwealth Health Insurance Connector Authority website contains extensive resources on the implementation and regulatory guidance.
