Amendment #9 to H.3452

QHP wrap enrollee protections

Ms. Benson of Lunenburg move that the bill be amended by striking out Section 87 and inserting in place thereof the following section:–

“Section 87. Section 3 of said chapter 176 Q is hereby amended by striking out clause (b) and inserting in place thereof the following clause:–

(b) to determine each applicant's eligibility for purchasing insurance offered by the connector, and to establish eligibility criteria and determine eligibility for premium assistance payments or point of service cost-sharing subsidies for applicants at or below 300 per cent of the federal poverty guidelines who are not eligible for any basic health program established pursuant to section 9 of chapter 118E, subject to the following conditions:

(1) premium assistance payments shall be determined based on the affordability schedule adopted pursuant to subsection (q); provided, that enrollees whose household income that does not exceed 150 per cent of the federal poverty guidelines shall be eligible for assistance to reduce their premium contribution to zero; provided further, beginning in 2015, an enrollee’s premium contribution as a percent of income shall increase as income increases, and provided further, that enrollees with household income that does not exceed 300 per cent of the federal poverty guidelines shall be eligible for assistance to reduce their premium contribution to no more than 5 per cent of household income.

(2) cost-sharing subsidies for enrollees whose household income does not exceed 138 per cent of the federal poverty guidelines shall not require such enrollees to be responsible for greater cost-sharing than amounts charged to individuals with the same income under the Medicaid program described under chapter 118E. Beginning in 2015, cost-sharing subsidies for individuals with income in excess of 138 per cent of the federal poverty guidelines shall be based on income categories no broader than 50 per cent of the federal poverty guidelines.

(3) persons eligible for premium assistance payments and cost sharing subsidies under this subsection shall be eligible to receive additional assistance during temporary periods of financial hardship and shall retain coverage while making payments pursuant to an approved payment plan. The board shall promulgate regulations regarding the criteria for a hardship and for payment plans.”