MassHealth-to-Commercial Shift on Hold – for Now

Governor Charlie Baker on Wednesday signed off on half of his plan to address growing costs in the state’s healthcare system; he signed a bill that raises the per-worker assessment on employers, but conceded – at least for now – that the legislature would not agree to the second part of his cost-reduction plan that included, among other elements, shifting 140,000 non-disabled people from MassHealth to commercial insurance. The governor previously had argued that the two elements of the plan had to go hand in hand.

That’s not to say that MassHealth reform is dead. Key legislators over the past few weeks said they objected to the governor’s rushed timetable for reforming MassHealth while agreeing that it is an issue that will need to remain under review.

And the governor has said on numerous occasions, including a recent talk with hospital officials, that his plan is not etched in stone; rather, he is open to a dialogue with legislators and stakeholders to manage enrollment growth in MassHealth and reduce state costs.

Baker has argued that the continuing shift of healthy people from their employer coverage to MassHealth, as well as uncertainty on future Medicaid funding from Washington, among other reasons, point to the need of encouraging access to commercial insurance coverage.

Last week, MHA President & CEO Lynn Nicholas, FACHE, said the hospital community could support the governor’s plan to limit non-disabled adults with incomes above 100% of the federal poverty level to eligibility for subsidized insurance in the Connector exchange rather than MassHealth. But only if there are protections for out-of-pocket expenses and for ensuring that enrollees can access coverage readily.  Among other conditions, MHA supports having a plan in place to ensure that if federal funds are reduced, there’s a transparent process to ensure that those affected are able to access coverage.