Overview of the Commonwealth Health Insurance Connector Authority

Additional information about the Commonwealth Health Insurance Connector Authority.

Overview

The Commonwealth Health Insurance Connector Authority (CCA) was established in 2006 by Chapter 58 of the Acts of 2006 and by Section 2 of Chapter 176Q of the Massachusetts General Laws to provide affordable health insurance to the citizens of Massachusetts. People who do not meet the required income eligibility levels to participate in the Commonwealth’s Medicaid program (MassHealth) are referred to CCA, whose function is to help them obtain affordable health insurance. To this end, CCA operates a variety of programs that offer subsidized and/or unsubsidized assistance to help people obtain health insurance. A description of each of the programs administered by CCA appears in the appendix to this report. The table below summarizes participation in CCA’s subsidized and unsubsidized programs.

CCA Enrollment

Calendar Year*	Subsidized Members	Unsubsidized Members	Total Members
2014	80,718	28,829	109,547
2015	175,539	54,057	229,596
2016	203,852	51,905	255,757

*     Figures for 2014 are from a December 2014 year-end report; figures for 2015 include data from January 2015 through December 2015; and figures for 2016 include data from January 2016 through June 2016.

The number of subsidized members as a percentage of total members increased from 76% in 2015 to 80% in 2016.

Massachusetts residents apply for health insurance through CCA by first submitting an application that requires information such as applicant name, Social Security number, date of birth, household income, family size, and place of residence. CCA uses the same regulations as MassHealth, Title 130 of the Code of Massachusetts Regulations, in determining whether an applicant is eligible to participate in the program and verifying information provided by applicants.

According to its website, CCA offers insurance from 13 health and dental providers: Altus Dental, Ambetter from CeltiCare Health, Blue Cross Blue Shield of Massachusetts, Boston Medical Center HealthNet Plan, Delta Dental, Dental Blue, Fallon Health, Guardian Dental, Harvard Pilgrim Health Care, Health New England, Neighborhood Health Plan, Minuteman Health, and Tufts Health Plan.

CCA is governed by an 11-member board that includes the Secretary of the Executive Office of Health and Human Services, who is the chair; the Secretary for Administration and Finance; the Commissioner of Insurance; the executive director of the Group Insurance Commission; four members appointed by the Governor; and three members appointed by the Attorney General.

Advance Premium Tax Credits and Subsidies

Massachusetts residents can receive financial assistance to pay for healthcare if they are United States citizens or can verify that their presence in the United States is lawful and they meet the applicable income eligibility requirements. Residents are ineligible for financial assistance if they can obtain coverage through Medicare or Medicaid, are currently in jail, or are offered affordable health insurance through their employers.

Financial assistance is provided in the form of the federal Advance Premium Tax Credit (APTC) and through other subsidies, including federal and state cost-sharing reductions (CSRs) and a state subsidy known as a state wrap.

The APTC is available to applicants with household incomes at or below 400% of the federal poverty level.¹ The amount of the APTC is calculated by CCA based on a member’s projected annual household income and is applied by CCA to the member’s monthly insurance premium. When a member files his/her federal income tax return, the member may be required to pay the excess APTC used if his/her actual annual household income exceeded the projected annual income, since the applied APTC would have been higher than what s/he was entitled to receive. A member would receive a tax refund if s/he overestimated his/her projected annual household income.

Federal and state CSRs are subsidies designed to lower an individual’s out-of-pocket costs and are advanced throughout the year to the insurance carriers operating in Massachusetts. The federal and state governments may be reimbursed at the end of the year if actual expenditures were less than what was advanced to the carriers. These subsidies are calculated and applied by CCA.

A state wrap is a subsidy based on an annual affordability schedule that corresponds to federal poverty levels. This subsidy is applied to a member’s monthly health insurance premium to further reduce it to an amount the state finds acceptable given the member’s income level. For example, a married couple living in Boston with a combined household income of $50,000 would qualify for a monthly tax credit of $75 to help reduce their monthly premium. The table below summarizes the subsidies provided by CCA during the audit period.

Health Insurance Subsidies by Type

Calendar Year*	APTC	State Wrap	State CSR	Federal CSR
2015	$230,290,157	$86,877,652	$63,808,336	$61,464,122
2016	$176,195,142	$56,833,178	$47,531,769	$46,607,310

*    Figures for 2014 were unavailable because of a change in CCA’s online system. Figures for 2015 include data from January 2015 through December 2015; figures for 2016 include data from January 2016 through June 2016.

APTCs accounted for approximately 53% of total subsidies in 2015 and 2016.

Online Portal

People applying for healthcare through CCA can do so via its Health Connector online portal, by completing a paper application in person, or by completing an application with CCA over the telephone. The applicant’s household information—which includes family size, projected yearly incomes of working household members, proof of Massachusetts residency, and whether any household members currently have health insurance—is entered in CCA’s database. CCA verifies an applicant’s reported income with the Internal Revenue Service and, starting in February 2016, the Massachusetts Department of Revenue. CCA verifies applicants’ residency using an online research tool called LexisNexis. If there are discrepancies between an applicant’s reported income or residency and CCA’s data, CCA sends the applicant a request for additional documentation to support his/her application.

Customer Service Contract with Dell Marketing LP

CCA entered into a contract with Dell Marketing LP in 2013. CCA hired Dell to create and operate a customer-service program for its Health Connector portal that consists of operating a call center, educating applicants about enrolling in health insurance plans, and processing bills that are paid online. Dell is accountable for 25 performance metrics, called service-level agreements (SLAs), 5 of which are directly related to customer service. These SLAs are based on daily, monthly, or quarterly data, which Dell tabulates and provides to CCA as stipulated in the contract. If Dell does not meet these SLAs, the contract states that CCA can assess penalties, which are to be applied to Dell’s monthly invoices and reduce the amount CCA owes to Dell. Conversely, the contract provides monetary incentives to Dell for exceeding the SLAs.

1. The United States Department of Health and Human Services annually publishes federal poverty guidelines based on family size and income that are used by various state and federal agencies to determine income eligibility for benefits. For example, for 2017 the federal poverty level was $20,290 for a family of two and $30,750 for a family of four.

Date published:	January 16, 2018