Amendment #878 to H3600

MassHealth Cost Containment

Representatives Lyons of Andover, Boldyga of Southwick, DeCoste of Norwell and Lombardo of Billerica move to amend the bill by inserting at the end thereof the following new outside sections: -

SECTION XXXX. Section 9A of chapter 118E of the General Laws, as appearing in the 2014 Official Edition, is hereby amended by inserting after paragraph (8) the following paragraph:-

(8 ½) In addition to premiums and copayments established by paragraph (8), the division shall establish a fee on each MassHealth health insurance plan to be paid by the beneficiary household, except a beneficiary household with an income equal to or less than the federal poverty level.

The fee due pursuant to this section shall be assessed on sliding scale commensurate with beneficiary household income levels; provided, that the total amount that shall be collected by the division from all beneficiaries, except beneficiaries with an income equal to or less than the federal poverty level shall be an amount equal to the number of MassHealth beneficiaries with an income above the federal poverty level multiplied by $2,000.

The division shall calculate the fee due from each beneficiary household by creating 6 beneficiary household income levels: (i) beneficiary households with an income greater than the federal poverty level but less than 133 per cent of the federal poverty level; (ii) beneficiary households with an income not less than 133 per cent of the federal poverty level but less than 150 per cent of the federal poverty level; (iii) beneficiary households with an income not less than 150 per cent of the federal poverty level but less than 200 per cent of the federal poverty level; (iv) beneficiary households with an income not less than 200 per cent of the federal poverty level but less than 300 per cent of the federal poverty level; (v) beneficiary households with an income not less than 300 per cent of the federal poverty level but less than 400 per cent of the federal poverty level; and (vi) beneficiary households with an income not less than 400 per cent of the federal poverty level.

SECTION XXXXX. Said chapter 118E is hereby further amended by adding the following section:-

Section 78. On or before March 30 of each year, the secretary shall apply to the federal Centers for Medicare and Medicaid Services for a waiver or amendment to a current waiver pursuant to section 1115 of the federal Social Security Act, 42 USC Section 1315, to allow the commonwealth to require the following: (a) no employee who is offered subsidized health insurance coverage by his employer shall be eligible for any healthcare program funded by the commonwealth; and (b) to institute a work requirement for all able-bodied adults receiving any health care services funded by the commonwealth. The work requirement shall: (1) require an eligible person to: (i) become employed, (ii) actively seek employment, which would be verified by the division, or (iii) attend a job training program; (2) require an eligible person to verify on a monthly basis compliance with requirements of subdivision (1) of this paragraph and any change in family income; (3) require the administration to confirm an eligible person's change in family income as reported pursuant to subdivision (2) of this paragraph and determine the person's eligibility under this article; (4) allow the administration to ban an eligible person from enrollment for 1 year if the eligible person failed to report a change in family income or made a false statement regarding compliance with the requirements of subdivision (1) of this paragraph.; and (5) allow for an exemption if a person meets any of the following conditions: (i) is at least 18 years of age but is still attending high school as a full-time student; (ii) is the sole caregiver of a family member who is under 5 years of age; or (iii) is currently receiving temporary or permanent long-term disability benefits from a private insurer or the government.

Upon the approval of such waiver pursuant to section 1115 of the federal Social Security Act, 42 USC Section 1315, for any of the requirements of this section, the secretary shall take all actions necessary to implement the requirements of this section.

SECTION XXXX. Chapter 176Q of the General Laws is hereby amended by adding the following section:-

Section 19. On or before March 30 of each year, the board shall apply to the federal Centers for Medicare and Medicaid Services for a waiver or amendment to a current waiver pursuant to section 1115 of the federal Social Security Act, 42 USC Section 1315,to allow the commonwealth to require that no employee who is offered subsidized health insurance coverage by an employer shall be eligible for a healthcare program funded by the commonwealth.

Upon the approval of such waiver pursuant to section 1115 of the federal Social Security Act, 42 USC Section 1315, the board shall take all necessary actions to implement this section.

Additional co-sponsor(s) added to Amendment #878 to H3600

MassHealth Cost Containment