Bill > S859

This bill establishes a public health insurance option in Massachusetts through the Commonwealth Connector, which will provide a government-backed health insurance plan available to eligible individuals and groups. The public option will be offered exclusively through the Connector starting January 1, 2027, for individuals and small groups, and by July 1, 2027, for large groups. The plan must meet the Connector's standards for minimum creditable coverage and receive the Connector's seal of approval. The Connector can contract with Medicaid managed care organizations to administer the plan, with the option to accept applications from other managed care organizations after January 1, 2027. The plan's premium rates will be set to fully cover health benefits and administrative costs, and provider payment rates will be based on Medicare rates with potential adjustments. Providers participating in Medicare will automatically be included in the public option unless they choose to opt out through a specific process. The bill also establishes a Public Health Insurance Trust Fund to support the program and includes provisions for risk adjustment among health plans to help balance the financial impact of enrolling individuals with different health needs. The legislation aims to increase healthcare choice, competition, and affordability in Massachusetts by providing a public health insurance alternative.

Health and Social Services

https://malegislature.gov/Bills/194/S859