During the recent round of MassHealth Training Forum meetings, we were informed that commercial fishermen who are eligible for the Fishing Partnership Health Plan are not eligible for Commonwealth Care, because they are eligible for another state-subsidized health plan. The non-profit FPHP is a fine program offering a great benefit package through Harvard Pilgrim. The premium subsidy of approximately 50% is funded by a combination of federal, state and private benefactor dollars. This is a great option for many fishermen.
However, the Connector's decision to exclude fishermen who earn less than $30,000 a year from Commonwealth Care coverage does not make sense. With the number of fishing days and catch limits imposed by federal and state mandate, the small in-shore fishing industry of the Outer Cape is barely viable. A typical Outer Cape fisherman is self-employed, earning less than 200% of the Federal Poverty Level (about $20,000 a year, before taxes) with a few of the more 'affluent' earning up to 300% of the FPL (just over $30,000).
According to the Connector's affordability tool, insurance costing more than $35 a month is unaffordable for someone earning less than 200% of the FPL, and for someone earning 300% of the FPL, the most affordable insurance can cost is $105. The $210 per month charge for FPHP insurance costs fishermen between two and six times more than what people at the same income level, but different jobs, are required to pay.
I understand the Connector's challenge to finance this major piece of legislation by looking to existing resources to insure the uninsured. But its affordability tool is applied inconsistently. Many individuals who are eligible by income are blocked from the affordable Commonwealth Care plans, because they are eligible for The Fishing Partnership's Health Plan or expensive employer-sponsored health insurance. They will remain uninsured.
Will they be able to gain exemption from the individual mandate? If not, they will end up worse off than before.
Thank you for this great
Thank you for this great post Priscilla. I think that if the least expensive plan available to these fishermen is more expensive than the affordability schedule says they can afford, they will not be penalized. At least, that's how it works for employer sponsored coverage, and I can't imagine it would be different for the FPHP. Still plenty frustrating.
Another group that should be
Another group that should be eligible for Commonwealth Care but isn't are students covered by QSHIP (Qualifying Student Health Insurance Program) plans. While the premiums for these plans may, at least in some cases, be considered affordable, the coverage is often terrible, with very low caps on many basic services. QSHIP plans are not subject to Minimum Creditable Coverage standards, but low-income students with access to these plans also are not eligible for Commonwealth Care. Instead they are mandated to purchase bad insurance.
A similar situation exists
A similar situation exists for people who have Insurance Partnership. As their premiums have increased every year the state subsidy does not so they still pay a very high percent of the premium, which is not affordable for people under 300%. We are seeing many people who had Insurance Partnership pre Commonwealth Care and would like to switch to Commonwealth Care. It is not clear if they can do this without having a possible 6 month waiting period or a gap in coverage. A recent client is paying $1100. per month with a $2000. deductible for a couple policy and Insurance Partnership is paying the maximum subsidy of $300. Do the math. It's not fair.
I think we all agree that
I think we all agree that there are a few populations of people that are unfortunately falling through health reform cracks due to the Commonwealth Care crowd-out provisions. The new Medical Benefit Request form (MBR) will enforce those provisions even more. The populations that this new version will disqualify for Commonwealth Care coverage are many. This applies to individuals who are currently enrolled in and deemed eligible for the following programs.
- QSHIP (full time)
- TRICARE (health insurance provided by the military)
- Fishermen's Partnership
- Medical Security Plan
- Access to affordable employer coverage (determined by affordability schedule)
It will also ask about subsidized health insurance that the applicant MAY BE eligible for. The section regarding Employer Sponsored Insurance (ESI) will now be a part of the main application, rather than a supplement as it has been in the past. This section is meant to deem those people that have access to 'affordable' ESI ineligible for Commonwealth Care benefits.
These restrictions have been laid out in Commonwealth Care regulations, which were approved at the end of 2006. While the rules have been in place for some time, MassHealth and the Connector have not been able to fully gather the criteria to catch people in these categories. We want to get the word out that getting on Commonwealth Care will be more restrictive this year.
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