Issues in Developing Programs for Uninsured Children: A Resource Book for States. Children’s Medical Security Plan of Massachusetts

03/02/1998

HISTORY:

Authorizing legislation for the Children’s Medical Security Plan (CMSP) was passed in 1993 to provide access to preventive and primary care services for Massachusetts' uninsured children. The plan originally covered uninsured children age 12 or younger. The impetus for the program was initially the national attention to health care reform and access to health care for all individuals. The passage of the Health Access Law in July 1996 expanded CMSP program eligibility to include adolescents up to age 18. In 1997 administration of the plan was transferred to the state Department of Public Health.

TARGET POPULATION:

The target population for CMSP is uninsured children under the age of 19 who are residents of Massachusetts and who are not eligible for Medicaid. The number of projected children eligible for CMSP is 76,000.

BENEFIT PACKAGE:

The Children's Medical Security Plan offers a range of benefits designed to cover the services most frequently used by children. Routine well-child check-ups, immunizations, and smoking prevention services are covered without co-payment. All other covered benefits require a co-payment of are $1, $3 or $5 based on family income guidelines. Limited coverage is offered for emergency care, prescription drugs, durable medical equipment, and outpatient mental health services. CMSP does not pay for OTC drugs, ambulance transport, inpatient care, dental care, or early intervention. However, children enrolled in CMSP may be eligible to receive inpatient care in any of the state hospitals or community health clinics through the state free care pool.

PROVIDER NETWORK AND REIMBURSEMENT:

The Community Health Plan (CHP) and John Hancock administer the health insurance program. The Community Health Plan serves three rural counties with approximately 3,000 participants. John Hancock serves the remainder of the state, with roughly 34,000 enrollees. John Hancock reimburses its providers on a fee-for-service basis, while CHP reimburses both through capitation and fee-for-service arrangements.

FINANCING

There are three sources of funding for the program: tobacco taxes, general funds, and family premium contributions. Families earning 200% or less of the federal poverty level receive the insurance free of charge. Those families earning below 400% of the poverty level are charged a reduced premium rate of $10.50 per child per month, with a $32.50 maximum per family per month. Families with income over 400% of poverty are charged the full premium, which is currently set at $52.50 per month.