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Health Coverage Related Services
Programs targeted to provide or facilitate the acquisition of health coverage for residents and employees of the Commonwealth in addition to overseeing health coverage market policies and regulation.
Program |
Description |
|---|---|
| Health Market Oversight | Programs targeted to monitor and regulate the health coverage market through oversight, policy, and quality assurance. |
| Drug Control and Prescription Monitoring | For the purpose of protecting consumers against fraud, deception and unsafe practices in the distribution, handling and use of pharmaceuticals by licensing pharmacies and monitoring the prescription of controlled substances. |
| Health Care Access | For the purpose of providing regulatory oversight of the small group and individual health insurance markets in order to ensure the provision of affordable health plans including the dissemination of information to consumers relative to health insurance coverage and access to affordable insurance products. |
| Health Market Analysis | For the purpose of monitoring the Massachusetts health care system and providing reliable information and analysis to improve health care quality, affordability, access, and outcomes. |
| Pharmaceutical / Medical Device Regulation | For the purpose of supporting the Pharmaceutical and Medical Device Code of Conduct which establishes standards for certain interactions between the pharmaceutical/medical device industry and health care providers/health plan administrators. |
| Health Connector Administration and Operations | For the purpose of administering and operating the Commonwealth Health Insurance Connector Authority to support cost-containment of health insurance for students, individuals and small businesses and to support other state and federal health reform efforts aimed at decreasing the rate of uninsured persons in Massachusetts. |
| Health Market Information Technology Infrastructure | For the purposes of developing and operating critical health market information technology infrastructure systems with providers to support MassHealth, Medicaid, and other health information technology systems including the Massachusetts Health Information Exchange and Health Insurance Exchange Integrated Eligibility System. |
Program |
Description |
|---|---|
| Subsidized Health Coverage | Programs targeted to provide or subsidize health coverage to individuals and families who meet state or federal eligibility requirements. |
| Commonwealth Care | For the purpose of maintaining access to affordable health insurance coverage for low-income residents of Massachusetts who are not eligible for Medicaid through a competitively procured health insurance premium assistance program. |
| State-Subsidized Wrap-around Program | For the purpose of reducing health insurance premiums for individuals and small businesses in Massachusetts by offering competitive subsidies through eligible health insurance carriers to reduce the cost of health insurance coverage for low-income residents who are not eligible for Medicaid. |
| Non-Disabled Adults Health Coverage (ACA Expansion) | For the purpose of providing affordable health insurance coverage for low-income individuals and families who have become newly eligible for State Plan coverage in 2014 due to the implementation of the Affordable Care Act (ACA). |
| Health Safety Net | For the purpose of reimbursing acute hospitals and community health centers for a portion of the cost of reimbursable health services provided to low-income, uninsured and underinsured residents. |
| Non-Disabled Adults Health Coverage (Traditional Medicaid) | For the purpose of providing health insurance to low-to-medium-income non-disabled adults for covered health care services. |
| Non-Disabled Children Health Coverage | For the purpose of providing health insurance to non-disabled children of low-to-medium-income families for covered health care services. |
| Disabled Adults Health Coverage | For the purpose of providing health insurance to low-to-medium-income disabled adults for covered health care services. |
| Disabled Children Health Coverage | For the purpose of providing health insurance to disabled children of low-to-medium-income families for covered health care services. |
| Seniors Health Coverage | For the purpose of providing health insurance to low- to medium-income seniors. Services are designed to provide comprehensive medical and social services to frail elders so that they are able to live in their communities instead of in nursing homes. |
| Long Term Unemployed Health Coverage | For the purpose of providing health insurance to long term unemployed adults for covered health care services. |
| Insurance Premium Payments and Subsidies | For the purpose of reducing the amount of out-of-pocket money paid for prescriptions and medical care for low- to medium-income individuals, families, and disabled persons. |
| Medical Assistance and Delivery System Incentive Hospital Payments | For the purpose of providing hospitals and health networks with supplemental payments for costs incurred for serving low-income populations with serious medical needs in order to promote integrated delivery systems, innovative care methods, alternative payment models, and population-level healthcare services. |
| MassHealth Administration and Operations | For the purpose of operating the MassHealth (Medicaid) insurance program providing health care for low- to medium-income and disabled persons. |
Program |
Description |
|---|---|
| Public Employees Health Coverage | Programs targeted to support health coverage costs of current and retired public employees including their family members and survivors. |
| Dental and Vision Insurance for Current Commonwealth Employees | For the purpose of providing dental and vision insurance for current Commonwealth employees, including processing dental and vision insurance payments pursuant to collective bargaining agreements. |
| Health Insurance for Commonwealth Employees | For the purpose of providing health insurance for Commonwealth employees, their spouses, and dependents |
| Health Insurance for Commonwealth Retirees and Survivors | For the purpose of providing health insurance for Commonwealth retirees, survivors, and their dependents. |
| Health Insurance for GIC-covered Municipal Employees, Retirees, and Survivors | For the purpose of providing health insurance for participating municipal employees, retirees, survivors, and their dependents, including those who entered through municipal health reform. |
| Health Insurance for Other GIC-covered Public Employees, Retirees, and Survivors | For the purpose of providing health insurance for employees, retirees, survivors, and their dependents for public entities such as housing and redevelopment authorities. |
| Public Employee Insurance Administration and Operations | For the purpose of providing administration of insurance benefits to state, municipal, and other public agency employees, retirees, survivors, and their dependents. |
| Health Insurance for Retired Municipal Teachers and Elderly Government Retirees | For the purpose of providing health insurance coverage for retired municipal teachers and a small number of municipal and state retirees and survivors whose retirement predated the established of group insurance benefits for their governmental unit. |
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