Medical Security Program, Take 5

We have recently blogged about the Medical Security Program (MSP): a plea to find state funding to save the program and a discussion of streamlining possibilities to prevent gaps in coverage. We’re pleased to report that the program is funded for another calendar year, thanks to creative thinking from the Administration. We can thank the Governor and legislature for a $30 million dollar appropriation. Additional funds will come from employers, though the employer assessment is still below the rate it would have been had it kept up with medical inflation, as called for in the statute (on this point, see law professor and bill language drafter Peter Enrich’s response to Mike Widmer’s claims to the contrary on the CommonHealth blog).

To cover the remainder of the shortfall, the Executive Office of Labor and Workforce Development, who runs the program, is making some administrative and programmatic changes. Yesterday, they sent updated information, posted on their website, to current enrollees.

Here’s what we know about the programmatic changes:

– Co-pays and deductibles will be tiered depending on provider and hospital, based on quality and cost measures

– Co-pays for primary care visits will move from $15 to $15/25/50

– Co-pays for specialist visits will increase from $30 to $50

– Co-pay for an emergency room visit will increase from $100 to $150

– Co-pays for prescription drugs will increase from $10/20/35 to $15/30/50

– Co-pays for inpatient/day surgery will change from $250 or $600 depending on the hospital to $150 with varying deductibles, depending on the hospital

– The out of pocket maximum will increase from $2,000 for an individual and $4,000 for a family to $5,000 and $10,000 (includes deductible, co-insurance and co-pays under $100)

More information on tiering:

– 8% of current enrollees live within 8 miles of 2 doctors at the $15 level, and 100% live within 8 miles of 2 doctors at the $25 level

– There are 39 hospitals statewide in the “enhanced” (cheapest) category; 14 in the “standard” (mid-level) category; and 23 in the “basic” (most expensive) category

Here’s what will stay the same:

– Income eligibility for the program is still to 400%

– Enrollee premiums are still $0

Here’s what we know about the administrative changes:

– Currently, an individual must be eligible for premium assistance for just one day of a month to receive coverage for that month. Now, one must be eligible for at least 10 days.

– Currently, those under 200% of the federal poverty level are given presumptive hardship waivers. Now, the presumptive level is 150%. (Anyone else may still apply for a hardship waiver.)

– Regulations will preclude those with access to spousal coverage to be eligible for MSP.
-Lindsey Tucker