Commonwealth Care Program Update

1
Commonwealth Care Program Update

• May 10, 2007

2
Program Overview

• Commonwealth Health Insurance Connector was
  created as part of the Health Care Reform
  legislation
• Creation of the Commonwealth Care program was a
  key element of the legislation
• Implemented October 1, 2006
• Serves individuals who are under 300 of the FPL

3
Commonwealth Care - Administration

• Private insurance plans offered exclusively
  through Medicaid Managed Care Organizations
  (MMCOs) for first three years
• The Connector serves as the exclusive
  administrator of Commonwealth Care premium
  assistance program
• Works closely with Medicaid program to determine
  eligibility

4
Role of Autoassignment

• Autoassignment is a key part of the program
  design
• Supports both programmatic and contract goals
• Rate negotiation enrollment
• MassHealth (sister program) has used
  autoassignment for a number of years

5
Basics

• Utilized for those individuals in the
  Uncompensated Care Pool that were determined
  eligible for non-premium paying categories
• Individuals were notified of their eligibility
  and sent a detailed enrollment packet
• Utilize a 14 14 60 day model for enrollment
  and plan changes

6
Commonwealth Care
Approx. 140,000 Individuals may be eligible for
Commonwealth Care Below 100 of FPL 48,000 UCP
members 6,000 Unknown to UCP Between 100 -
300 of FPL 62,000 UCP members 24,000 Unknown
to UCP
7
Enrollment Breakdown

• 69,000 enrolled as of May 1
• 53,768 enrolled in Plan Type 1 (autoassigned)
• Plan Types 2, 3 4 (15,560)
• Autoassignments were completed over a three month
  period
• Allowed for better management of call volume
  enrollment

8
CommCare Membership Churn
9
Commonwealth Care Enrollment
10
Autoassignment Methodology

• Commonwealth uses Service Areas to determine
  coverage (38 areas)
• Full coverage of the State
• Only a few areas only have one MCO available
• Enrollment system (MMIS) is programmed to assign
  people no manual intervention is required

11
MCO Negotiations

• Initial Connector position was to auto assign all
  enrollees to the lowest bidder in a service area
• Based on MMCO negotiations, Connector modified
  proposal as follows
• Any MMCO within 3 of the lowest bidder, will
  also receive some percentage of the auto-assigned
  enrollees
• The ratio of enrollees assigned to the lowest in
  comparison to the others will be 31
• Composite calculation will be performed at the
  beginning of the contract using estimated
  enrollment again on July 1 using actual
  enrollment (prospective only)

12
Assignment Model
of MCOs of MCOs of MCOs of MCOs
2 3 4
of enrollees lowest bid of enrollees lowest bid 75 60 50
of enrollees 2ND lowest bid of enrollees 2ND lowest bid 25 20 20
of enrollees 3RD lowest bid of enrollees 3RD lowest bid NA 20 15
of enrollees 4TH lowest bid of enrollees 4TH lowest bid NA NA 15
Only two MMCOs were within the 3 range for the
10/1/2006 effective date
13
Challenges

• Were only able to achieve a 50 self-selection
  rate for first group
• Working on ways to increase this
• 60 Day Lock in policy has caused challenges in
  some areas
• Has taken time to find the right balance on MCO
  marketing to members