State Marketplace Profiles: Connecticut

Final update made on September 27, 2013 (no further updates will be made) 

Establishing the Marketplace

On July 1, 2011, Governor Dan Malloy (D) signed SB921 (Public Act 11-53) into law establishing the Connecticut Health Insurance Exchange.¹  Legislation altering the composition of the Exchange Board passed in June 2012.²³ In December 2012, the Exchange announced that its new name would be “Access Health CT.”

Structure: The legislation defines Connecticut’s Health Insurance Exchange as a quasi-governmental organization, specifically “a body politic and corporate, constituting a public instrumentality and political subdivision of the state…which shall not be construed to be a department, institution or agency of the state.”

Governance: Access Health CT is governed by a 14-member board including six ex-officio members. Elected officials appoint eight of the twelve voting members. The Governor appoints two members, one with expertise in individual health insurance coverage and one with expertise in small employer health insurance coverage; the President pro tempore of the Senate appoints an expert in health care finance; the Speaker of the House of Representatives appoints someone knowledgeable in health care benefits plan administration; the Majority Leader of the Senate appoints an expert in health care delivery systems; the Majority Leader of the House of Representatives appoints a health care economist; the Minority Leader of the Senate appoints a person with expertise in health care access issues facing self-employed individuals; and the Minority Leader of the House appoints someone knowledgeable in barriers to individual health care coverage. The four voting ex officio Board members (or their designees) include, the Commissioner of Social Services, the Special Advisor to the Governor on Healthcare Reform, the Healthcare Advocate, and the Secretary of the Office of Policy and Management; non-voting ex officio Board members (or their designees) include, the Insurance Commissioner and the Commissioner of Public Health.

Board members cannot have affiliations with any of the following entities while on the Board: an insurer, an insurance producer or broker, a health care provider, a health care facility or clinic, or trade associations for these entities. Also, members cannot be health care providers receiving compensation for services nor have ownership interest in a professional health care practice. These conflicts of interest provisions apply to Marketplace staff as well as the Board, though Board Members are also prohibited from working for a health care carrier that offers a plan through the Marketplace for the year after serving on the Board.

Current appointed Board members are:

• Nancy Wyman (Chair), Lieutenant Governor
• Mary Fox, formerly with Aetna Product Group
• Robert Scalettar, MD, formerly with Anthem Blue Cross Blue Shield
• Bob Tessier, Connecticut Coalition of Taft Hartley Health Funds
• Cecilia Woods, Permanent Commission on the Status of Women
• Grant Ritter, Schneider Institutes for Health Policy at Brandeis University
• Paul Philpott, Quo Vadis Advisors, LLC
• Maura Carley, Healthcare Navigation, LLC

The Board hired its first Marketplace CEO in June 2012 after holding meetings for nearly a year prior. Consumer groups continue to express concerns that a number of Marketplace Board members have close affiliations with the insurance industry while consumers and small businesses remain under represented.⁴⁵

Connecticut’s Exchange legislation requires the Marketplace Board to report annually to the Governor and General Assembly on a variety of issues. The Board must also make any necessary legislative recommendations to reduce the negative impact on the sustainability of the Marketplace. The first annual draft report by the Marketplace Board to the General Assembly was released in January 2012 and updated in February.⁶

Advisory committees established in March 2012 meet monthly to assist in Marketplace policy development and evaluation in four key areas: health plan benefits and qualifications; Small Business Health Options Program (SHOP); consumer experience and outreach; brokers, agents, and Navigators.

Contracting with Plans: The Marketplace has the legal authority to function as an active purchaser, “limit[ing] the number of plans offered, and us[ing] selective criteria in determining which plans to offer, through the exchange, provided individuals and employers have an adequate number and selection of choices.” In October 2012 however, the Board decided to allow any (Qualified Health Plan) QHP meeting selected criteria to be sold on Access Health CT for 2014. The Marketplace acknowledges that for 2015 and later, they can still opt for a competitive bidding process and develop selective contracting criteria.⁷

The legislation does not describe the contracting requirements, but requires the Board to adopt written procedures to explain requirements for certification of qualified health plans. At a minimum, carriers participating in Access Health CT must offer one standard plan for each of the bronze, silver, and gold tiers. Issuers in both Marketplaces may opt to offer a standard plan for the platinum tier, and issuers in the individual Marketplace may choose to offer a catastrophic coverage plan. Plans participating in the individual Marketplace must submit three silver alternative standard plans that reflect cost sharing reductions, two zero cost-sharing plans for American Indians, and a child-only plan.⁸ Plans offered within the Marketplace must charge the same premium as when offered outside the Marketplace, whether sold by an insurance producer or directly by the carrier. Carriers must publicly justify any increase in premiums of plans offered within the Marketplace.

Issuers may choose to participate in the individual Marketplace, the SHOP Marketplace, or both. Issuers meeting certification standards will be certified to participate on Access Health CT for two years; however, issuers that stop participating will not be allowed to re-enter the Marketplace for at least two years. Four carriers were certified to offer coverage through Access Health CT, but in August 2013, one carrier withdrew.⁹ QHP benefits and plans must be filed and certified annually.¹⁰ The Connecticut Insurance Department (CID) is responsible for reviewing and approving rate filings and rate increases. Issuers may rate based on age and geography, but tobacco rating will be prohibited in the individual market for 2014. In August 2013, the CID approved final rates for plans that will be offered through the individual and SHOP Marketplace.

Provider networks for each QHP must meet Utilization Review Accreditation Commission (URAC) or National Committee for Quality Assurance (NCQA) standards and satisfy the requirements of the Special Rules For Network Plans of the Public Health Service Act. Issuers must ensure that the network of providers for standard plan offerings is comparable to the network of providers available for a similar product offered outside Access Health CT. The network must also include a sufficient number of Essential Community Providers and providers that specialize in mental health and substance abuse services.

Issuers will be required to report quality information to Access Health CT, as well as results from the enrollee satisfaction survey system developed by HHS. Access Health CT will use the information to develop and maintain a quality rating system that will relate quality of care to price, per metal-level tier.⁸

Risk Adjustment, Reinsurance, and Risk Corridors: Connecticut intends to administer its risk adjustment and reinsurance programs.¹¹ In June 2012 Governor Malloy signed Public Act 12-166 into law establishing the requirement for an all-payer claims database (APCD), which will  provide data to state agencies, including the Marketplace, for purposes of reviewing health care utilization, cost, and quality data. Such a database will provide the baseline information to create a risk adjustment program, as well as to provide outcome quality data and enable analyses of Marketplace policy initiatives. The Office of Health Reform and Innovation is developing the APCD program and established an APCD Advisory Group to guide the implementation process. Access Health CT received $6.5 million in Establishment Grant funding for the APCD program in August 2012.¹² The APCD Advisory Group released a Request for Proposals (RFP) for a data manager in late July of 2013 and will select a vendor in November. The APCD is expected to be operational and collecting monthly data submissions by August of 2014.¹³

Dental and Vision Benefits: In order to offer a stand-alone dental plan through the Access Health CT Marketplace, issuers must provide three plan design options: high (85% Actuarial Value), low (75% Actuarial Value), and wellness (limited set of preventive and diagnostic services). Access Health CT requires all carriers submitting a QHP to separately price their pediatric dental essential health benefit.

Consumer Assistance and Outreach: In August 2013, Access Health CT awarded grants to six regionally-based Navigator organizations that will be responsible for developing and implementing regional outreach strategies. Navigators will also provide support and direction to Assisters in their region. The Access Health CT Marketplace has awarded $6,000 grants to approximately 300 Assisters statewide who work at community-based organizations and will provide one-on-one education and enrollment services to consumers. Assisters are distributed based on concentrations of the uninsured throughout the state. Navigators and Assisters must complete up to 40 hours of training, pass a certification test and a background check, and carry photo identification badges.¹⁴ In February 2013, Access Health CT contracted with a vendor to build and service the call center, and the call center launched in September. Over 70 call center representatives are available to serve consumers seeking information about coverage through Access Health CT.¹⁵

Brokers who intend to sell coverage through the Access Health CT Marketplace must complete a certification program as well as a training program specific to the market in which they wish to sell (individual and/or SHOP). They must pass a comprehension test after completing the training curricula.¹⁶ As of mid-September, over 600 brokers had been certified and trained.¹⁷

In November 2012, Access Health CT hired a marketing vendor and developed a marketing and community outreach plan and timeline. The outreach campaign includes the use of media, direct mail, in-person events, social media, public relations, and brokers.¹⁸  In February 2013, Access Health CT unveiled their logo and launched their website, including a subsidy calculator. In mid-June, Access Health CT launched a marketing campaign, including television, print, outdoor, and online advertising, to raise awareness about the Marketplace. Access Health CT also began community outreach efforts in June and connected with almost 7,000 individuals, half of whom will qualify for subsidies through the Marketplace, at fairs, festivals, concerts, retail outlets, and “Healthy Chat” events.¹⁷ In September 2013, the Marketplace launched a television series titled Mercado de Salud, that will engage and educate the Hispanic community about Access Health CT.¹⁹ Access Health CT is also working to build two Marketplace retail locations, where consumers will have access to in-person education and enrollment services. The storefronts are expected to open in mid-October.

Small Business Health Options Program (SHOP) Marketplace: In 2012, the Access Health CT Board decided to establish separate risk pools for the small group and individual markets but to use a single administrative Marketplace to operate both programs. The Board also decided Connecticut should limit the definition of small employers to groups of 50 or fewer employees until it is required to expand the definition to groups of 100 or fewer employees in 2016.¹² Employers will be able to choose between employee choice, employer choice, and sole source coverage models for their employees. In April 2013, Access Health CT hired a subcontractor to develop and manage the front-end and administrative platform for the SHOP. Access Health CT plans to launch the SHOP on October 1, 2013, despite the decision by HHS to allow states to delay implementation until 2015.

Financing: Public Act 11-53 authorizes the Marketplace to charge health carriers capable of offering a qualified health plan through Access Health CT an assessment or user fee. In May2013, the Board approved a 1.35% marketplace assessment on all small group and individual market insurers, as well as dental carriers.²⁰ The assessment rate is based on Access Health CT’s estimated annual operating cost of $34.5 million.²¹

Basic Health Program (BHP): Connecticut is considering establishing an optional bridge program available through the Affordable Care Act (ACA) which allows states to use federal funding to offer subsidized health insurance to adults with incomes between 139 and 200% of the federal poverty level (FPL) who would otherwise be eligible to purchase subsidized coverage through the Marketplace. The Office of Health Reform and Innovation established Work Groups, including one on the Basic Health Program, which began meeting in April 2012 to develop recommendations. Legislation establishing a Basic Health Program was introduced but tabled for the 2012 legislative session (HB 5450).²² Due to the lack of federal guidance, it has been difficult for the state to move forward with planning a BHP.²³

Essential Health Benefits (EHB): The Affordable Care Act requires that all non-grandfathered individual and small-group plans sold in a state, including those offered through the Marketplace, cover certain defined health benefits. States must decide whether to benchmark their EHB plan to one of ten plans operating in the state or default to the largest small-group plan in the state. The Access Health CT Board recommended the state use ConnectiCare’s HMO plan as the benchmark plan, the Children’s Health Insurance Program (CHIP) as the pediatric dental supplement, and the Federal Employee Vision Plan (FEDVIP) as the pediatric vision supplement.²⁴

Marketplace Funding

The Connecticut State Office of Policy and Management received a federal Exchange Planning grant of $1 million in September 2010 and a federal Level One Establishment grant of $6.7 million in August 2011 to work on IT systems and develop appropriate capacity for consumer assistance and reporting requirements. The state filed a Level One grant application request for $21.9 million in September 2013. The Exchange was awarded a Level Two Establishment grant in August 2012 for $107.3 million to fund Exchange development through December 2014. In February 2013, the state was awarded a second Level One Establishment grant for $2.1 million to fund the implementation of an In-Person Assisters program.²⁵

In addition, Connecticut is a member of the consortium of New England states that received a federal Early Innovator Grant of $44 million to develop, share, and leverage insurance exchange technology. The multi-state consortium also includes Rhode Island, Maine, Vermont, and Massachusetts with the University of Massachusetts Medical School as the grant holder.²⁶

Next Steps

On December 7, 2012, Connecticut received conditional approval from the U.S. Department of Health and Human Services (HHS) to establish a State-based Marketplace.²⁷ The Access Health CT Marketplace portal will become operational on October 1 and will begin enrolling qualified individuals, families, and small businesses into coverage.

Additional information about Access Health CT can be found here.