MassHealth Premiums

1
MassHealth Premiums

• Premium structures and operational issues in the
  MassHealth program

Christy Bonstelle, Sr. Policy Analyst, Office of
Medicaid Massachusetts Executive Office of Health
and Human Services June 2004
2
MassHealth 1115 Waiver Coverage Types

• Base
• Standard
• Prenatal
• Limited

• Expansion
• Family Assistance
• CommonHealth
• Basic
• Essential

3
Initial Premium Groups

• Family Assistance
• Covered Children , incomes 150-200 FPL,
  certain adults, incomes lt200 FPL
• Monthly Premium Schedule 12/Child with a
  maximum of 36/Family
• CommonHealth
• Covered Disabled individuals, incomes gt 133
• Monthly Premium Schedule For those gt150 FPL,
  sliding scale premiums

4
Additional Premium Groups (Introduced in
November, 2003)

• Standard Children
• Covered Children , incomes lt150 FPL
• Monthly Premium Schedule For those over 6 years
  of age and gt133 FPL, 12/Child with a maximum
  of 15/Family
• Standard Disabled
• Covered Disabled individuals, incomes lt 133
• Monthly Premium Schedule For those gt114 FPL,
  sliding scale premiums

5
Current MassHealth Premium Structure
Family Assistance CommonHealth Standard Children Standard Disabled
100-114 12/child, 15 family max 27/childless adult, 15/ family None None
114-133 12/child, 15 family max 27/childless adult, 15/ family None 12/ family
133-150 12/child, 15 family max 27/childless adult, 15/ family 12/child, 15 family max N/A
150 12/child, 36 family max 27/childless adult Sliding scale N/A N/A
6
Day-to-Day Operations

• Collecting premiums
• Protecting eligibility
• Providing customer service

7
Collecting Premiums

• Premiums collected by an internal billing unit
• Billing unit must coordinate across agencies
• Premium billing process is labor intensive
• Forms of payment accepted
• Forms of payment that are easy for members

8
Protecting Eligibility

• Member rights
• Providing written information
• Coordination between eligibility and billing
  units
• Complex families
• Changes in family situation
• Payment plans and hardship waivers

9
Waivers for Extreme Financial Hardship

• Defining extreme financial hardship
• Tracking, reviewing and granting or denying
  waiver applications
• Use of application to report change in family
  status

10
Customer Service

• Why do I have a premium? (Eligibility)
• How do I pay my premium? (Billing)
• Limiting bouncing back and forth

11
Points to Consider when Introducing Premiums

• Complexity of premium schedule
• Efficiency of premium billing and collection
  process
• The link between premium collection and member
  eligibility