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Massachusetts Law About Health Insurance

Massachusetts Law

MGL c.111M Individual Health Coverage. The Massachusetts Mandated Health Insurance Law, added by St. 2006, c.58, which also amended many other sections. Key provisions of the law include subsidized health insurance for residents earning less than 300% of the Federal Poverty Level, and low-cost insurance for all other residents who are not eligible for insurance through their employers.

St. 2012, c.224 An Act Improving the Quality of Health Care and Reducing Costs through Increased Transparency, Efficiency and Innovation. Health Care Cost Reduction. Signed Aug. 6, 2012. Various sections effective 2013-2017. See sections 281A-308 for specific effective dates.

MGL c.175I through MGL c.176Q cover various types of health insurance, including HMO, PPO, Group, Non-Group and more.

Massachusetts Regulations

956 CMR: Commonwealth Health Insurance Connector Authority

Federal Law

Patient Protection and Affordable Care Act, PL 111-148 (HR 3590). The federal Health Care law is over 900 pages long. Changes include increased protection for those with pre-existing conditions, heightened penalties for certain employers who don't provide insurance, additional availability of insurance for children up to age 26, closure of the medicare "donut hole" for prescription drug coverage and more.

Thomas More Law Center v. Obama, 6th Circuit Court of Appeals, June 29, 2011. "[T]he minimum coverage provision [individual mandate] is a valid exercise of legislative power by Congress under the Commerce Clause."

Selected Case Law

Finch v. Commonwealth Health Insurance Connector Authority, 461 Mass. 232 (2012). Coverage for legal immigrants. "Section 31(a) [of St.2009, c.65] cannot pass strict scrutiny. The discrimination against legal immigrants that its limiting language embodies violates their rights to equal protection under the Massachusetts Constitution."

Web Sources on the Mass. and Federal Laws

7 Changes to Expect in Your Health Coverage This Year, Boston.com, January 2011. Explains the biggest changes to federal health insurance law effective this January. "The federal health law supersedes Massachusetts law, so any provisions that conflict with your current state health plan will likely mean adjustments in your coverage."

Eligibility of Non-Citize‚Äčns for MassHealth & other subsidized coverage, 2014 Mass. Legal Services, 2014: " This Feb. 2014 memo summarizes the current immigrant eligibility rules applicable to pregnant women, children, young adults, and other adults for MassHealth and other subsidized health coverage and includes tables listing different categories of immigrants eligible for different kinds of benefits under health program rules."

Massachusetts Health Connector. This is the state agency managing mandatory health insurance. Come here to apply for insurance or buy a health plan.

The 2006 Massachusetts Health Care Reform Law: Progress and Challenges After One Year of Implementation, Blue Cross/Blue Shield Foundation of MA, Mass. Medicaid Policy Institute, and Mass. Health Policy Reform, May 2007. Outlines progress made to date, including implementation, infrastructure, community outreach and more. Also projects future issues and challenges.

Consumer Guide to Health Care Coverage, Mass. Office of Consumer Affairs. Extensive resource details who has to have insurance, types of plans, costs, finding a provider and more.

HealthCare.gov. Gateway to federal health insurance programs. You can get information about how the federal law affects you and much more. Massachusetts residents can explore plans and sign up using the Massachusetts Health Connector, above.

The Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act, Democratic Policy Committee. Includes summary and analysis of the federal law, including an explanation of immediate benefits, section-by-section analysis, and an implementation timeline.

Re-Forming Reform: What the Patient Protection and Affordable Care Act Means for Massachusetts, Robert W. Seifert and Andrew P. Cohen, Center for Health Law and Economics, University of Massachusetts Medical School, June 2010. Detailed report explains positive and negative efffects of the federal law on Massachusetts residents.

Tax Information on Health Care Reform, Mass. Dept. of Revenue. Includes information on the tax implications of health care reform, with forms and more, for individuals, employers and insurance carriers.

What the Health Care Law Means for Massachusetts, Boston Globe, March 22, 2010. Lists key provisions of the federal law and differences with Massachusetts law.

Your Guide to Managed Care in Massachusetts, Mass. Division of Health Care Finance and Policy (DHCFP) and the Mass. Office of Patient Protection (OPP). 43-page guide "that will help you: Learn the differences between different types of health insurance and how those differences affect you, Choose a health plan that best meets your needs, File an appeal or complaint with your health plan if the need arises, and Find additional information on health plans.

Other Health Insurance Issues

St.2010, c.207, Insurance Coverage for Autism. Effective Jan. 2011. Mandates coverage for particular interventions.

St. 2002, c.49, An Act Providing Equitable Coverage of Services Under Health Plans. Requires most insurers to provide coverage for hormone replacement therapy and contraceptives.

Frequently Asked Questions About COBRA Continuation Health Coverage, US Dept. of Labor. Includes information on eligibility and more.

Same-Sex Spousal Health Benefits: In Massachusetts After Goodridge, GLAD, November 2011. Covers private sector, public sector, federal employees, self-employed, COBRA, those who work outside of Massachusetts, and more.

Print Sources

Health Care Reform: Yesterday and Tomorrow, Center for Advanced Legal Studies, 2010.