How will health care reform affect you and your patients?
What are the key elements of the legislation?
- Legislation was signed 4/12/2006 to reform the Massachusetts healthcare system and maintain federal Medicaid funding of $385M
- The intent is to provide coverage for 90-95% of the uninsured in Massachusetts over the next 3 years
- Reduce the cost of health care for consumers, businesses and taxpayers
- Empower consumers through choice, quality care and comparative information
- Improve the public health of the Commonwealth for all its citizens
- Reduce the use of free care at hospitals and community health centers
What is the Commonwealth Health Insurance Connector?
The Health Connector is a new centralized agency through which small businesses (less than 50 employees) and individuals will be able to purchase health care coverage.
The Health Connector:
- Will connect individuals and businesses to quality, affordable, private coverage through a new state authority
- Reduces cost through pre-tax treatment of premium contributions through Section 125 cafeteria plans
- Allows businesses to contribute monies on behalf of their employees for their health insurance
What changes are being made to the MassHealth program?
The health care reform legislation:
- Expands MassHealth eligibility for children up to 300% federal poverty level
- Secures Medicaid waiver which funds care for the uninsured
- Restores dental and vision services, chiropractic, and prosthetics benefits that were cut in 2002.
Will financial assistance be available for low-income individuals?
- Low-income uninsured adults (at or below 150% of the federal poverty level) who are not eligible for MassHealth now have access to comprehensive private insurance with no monthly premiums or deductibles through the Commonwealth Care program.
- Starting 1/1/2007, plans were made available, through the Commonwealth Care program, to individuals with incomes between 150.1% and 300% of the federal poverty level. These individuals will be eligible for financial assistance based on their income.
- These plans are available through the newly created Commonwealth Health Insurance Connector.
- Fallon Community Health Plan is one of four health plans participating in this program. FCHP is proud to offer Commonwealth Choice FCHP Direct Care to members who meet the requirements to participate in the Commonwealth Care program. To find out if an individual is eligible, he or she can call 1-877-MA-ENROLL.
What are the individual and employer health care mandates?
Effective 7/1/2007, the health care reform legislation will require that all Massachusetts residents have health insurance coverage.
- Beginning 7/1/2007, individuals who are above the income threshold but don't purchase insurance will be penalized on their state income taxes.
Under the new legislation, employers with with 11 or more full-time equivalent employees are required to offer cafeteria plan coverage to their employees, either under its own group health plan or through the Commonwealth Health Insurance Connector.
- A new “Fair Share Contribution” and “Free Rider Surcharge” will encourage employers to contribute toward employee coverage.
What public health improvement initiatives and market efficiency improvements does the legislation encourage?
- Reduce cost-shifting to private insurance by minimizing the use of the free care pool
- Invest $5,000,000 for Computerized Physician Order Entry Systems initiative that reduces medical errors
- Increase funding for certain prevention programs (cancer screening, diabetes education, etc.)
- Establish state board and Web site comparing cost and quality of health care from different hospitals and providers to enable consumers to find the most efficient quality care
- Disclosure of average charges and payments accepted for certain commonly performed services at hospitals, physicians’ offices and community health centers
Who can I contact if I have more questions?
You can contact FCHP's Provider Relations Department by phone at 866-ASK-FCHP.
Updated 7/3/2007