Drawn from the report, States' Roles in Shaping High Performance Health Systems.
States shape the health system in many ways, influencing key components such as insurance coverage, quality of care, and information and provider infrastructures. This report presents findings from the State Health Policies Aimed at Promoting Excellent Systems project, undertaken by the National Academy for State Health Policy, with support from The Commonwealth Fund. After conducting surveys of multiple agencies in states across the country, as well as review of related literature, this study found that states are pursuing system improvements across the full spectrum of their authority, including health care purchasing, regulation of providers, reporting of performance data, integration of public health with health care approaches, and improving the availability and affordability of health insurance. Despite this activity, this study finds room for states to do much more. Ongoing efforts to track, study and diffuse information on state activities could accelerate adoption of promising polices and practices.
Providing affordable coverage is a key component of Massachusetts' recent health reform, which includes an individual mandate to buy health insurance. Uninsured residents (i.e., citizens and legal immigrants) falling below 300 percent of the federal poverty level now qualify for some type of subsidized insurance. They can enroll in coverage either through MassHealth (the traditional Medicaid and SCHIP program) or Commonwealth Care, a tiered insurance product with benefits and cost-sharing requirements that vary by income and delivered by the same managed care organizations as MassHealth. To simplify enrollment, the programs all use a single application and the MassHealth agency reviews all applications to determine qualification.
This approach of a common eligibility ceiling and system avoids the confusion that comes with complicated federal Medicaid categories under which children, pregnant women, parents, and others are eligible at different levels of income. The Massachusetts approach allows families and adults to more easily identify themselves as eligible and enroll in coverage.
The financing structure and new eligibility groups resulted from Medicaid waiver negotiations with the federal government. Massachusetts was in danger of losing $385 million in federal matching funding that it had previously received to support safety net hospitals. The waiver agreement allowed the state to redirect those funds to purchase coverage for individuals.
People with incomes above 300 percent of poverty are expected to buy insurance on their own. However, to assist with affordability, new insurance products will be offered through the state's new Connector agency, or through employers.
Sources: Massachusetts Medicaid SHAPES survey and the Commonwealth Connector website, http://www.mass.gov/?pageID=hichomepage&L=1&L0=Home&sid=Qhic