Senate Bill 6: Implementation of the Small

Employer Health Benefit Premium Subsidy Program

May 15, 2008

Rex Cowdry, M.D.Executive Director

Maryland Health Care Commission

ACCESS and COVERAGE

Who are the uninsured in Maryland?

“The uninsured” is not a single group but rather many different groups without insurance for widely varying reasons and for varying lengths of time

780,000 individuals, 14.2 % of the total population – 15.8% of the under-65 population

575,0001,100,000

including 140,000 childrenincluding 140,000 children

Current Population Survey (CPS) estimate of 780,000 uninsured in Maryland probably corresponds best to individuals uninsured for more than 3 months during the year, slightly lower than the “specific point in time” estimate.

Using the CBO report and adjusting for changes in the surveys over the past 8 years:

Equivalent to CPS estimate - 780,000 Maryland residents

Equivalent to 450,000 to 650,000 Maryland

residents

Equivalent to 1,000,000 to 1,100,000 Maryland

residents

•Maryland residents uninsured for the entire year = between 450,000 and 650,000

•Maryland residents uninsured at any time during the year = 1,000,000 to 1,100,000

Comparison of Maryland with the entire United States

Health Care Coverage of the Non-elderly 2004-2005

45,500,000

780,000

Effects of Age:Uninsurance rates are highest among 19-44 year olds

Young adults (19-29)

•Relatively healthy

•Lower health expenditures

•Being uninsured may be a rational choice if price is high relative to benefit

•“Young immortals” may not purchase even at a low price

•Mandate or penalties may be necessary to motivate purchase

Income:

25% of the uninsured have incomes above 400% of the Federal Poverty Level (approximately $40,000 single and $80,000 family of four)

Income:

47% of the uninsured have incomes below 200% of the Federal Poverty Level(approximately $20,000 single and $40,000 family of four)

Uninsured by Age & Family Income2004-2005

Low Income

(0-200%)

Mod. Income

(201-400%)

High Income

(401%+)

Uninsured Uninsured Uninsured

Ages Rate Share Rate Share Rate Share

0-18 .19 10% .07 4% .04 3%

19-34 .46 16% .28 12% .13 9%

35-64 .40 21% .18 12% .07 12%

Family composition:Over half the uninsured are adults without children

Family composition: Single males are least likely to have coverage

Citizenship and the Uninsured

Rates of uninsurance are much higher among non-citizens at all income levels.

For non-US citizens, rates of uninsurance remain high even in high income families

27% of the uninsured are not US citizens

There are substantial racial and ethnic disparities in coverage

At a given income level, uninsured rates are generally similar across racial and ethnic groups; except that...

at each income level, Hispanics are more likely to be uninsured

69%

9%

16% ~780,000

2004-2005

Trends in Maryland Health Insurance Coverage Marylanders under age 65, 2001-2005

Employment-based

Direct purchase

Medicaid

Other public

Uninsured

7%

6%

~740,000

77%

72%

5%

5%

4%

5%

13%

15%

2000-2001

2002-2003

6%

7%

Employer sponsored health insurance

Premiums continue to rise faster than wages underwriting cycle provider consolidation and bargaining pressures technology, technology, technology (pharma)

Employers have generally not increased the employee’s share of the premium, but are increasing employee deductibles, co-pays

Employers are considering greater cost shifting, the use of defined contribution plans, and an end to retirement health benefits

Employers are also changing incentives Employee incentives through HSAs, wellness, copays Provider incentives through P4P, tiered providers, Leapfrog

Some employers, particularly small businesses, are dropping coverage Employment-based coverage declined from 77% to 72% from 2000 to 2003

83% of the uninsured live in a family with one or more workers

Employer-sponsored insurance: Coverage rates are substantially lower in small Maryland firms

Firms with under 100 employees have 57% of the uninsured employees in Maryland (but only 37% of the workers)

Firms with under 25 employees have 42% of the uninsured employees in Maryland (but only 25% of all workers)

Public Coverage(Effective 07/01/06)

Note: This chart is for illustrative purposes only. Each coverage group has specific eligibility and some asset requirements, which are not shown.

200

100

300

133

40

Age 65 and Over+

19610 Parents or disabled age 19 to 64

250

PW

185

Poverty Level:1 person = $10,2102 persons =$13,6904 persons = $20,650

As of 1/24/2007

MCHP Premium

MCHP

Medicaid

Primary Adult Care Program – 116% FPL

Pregnant Women

Medicare

300

Adult Medicaid Eligibility, 2004-2005

EligibilityMar

ylan

d

Mas

sach

uset

ts

Verm

ont

Dis

tric

t of

Colu

mbi

a

Mai

ne

Min

neso

ta

0

50

100

150

200

250

300

Elig

ibili

ty (%

FPL)

Cata

mount

Dir

igo

Com

monw

ealt

h

Maryland significantly trails leading states in Medicaid eligibility for parents

Median Income

010203040506070

Inco

me (t

housa

nds

of

dolla

rs)

Median Income and

“Safety Net”FQHCs In Maryland

Source: Mid-Atlantic Association of Community Health CentersSource: Mid-Atlantic Association of Community Health Centers

There are 14 FQHCs (38% serve rural Maryland) and 2 FQHC There are 14 FQHCs (38% serve rural Maryland) and 2 FQHC look-alikes that operate over 82 health centerslook-alikes that operate over 82 health centers

Summary: Who are the uninsured in Maryland? 780,000 individuals, including 140,000 children

14.2 % of the total population – 15.8% of the under-65 population

The majority are young and healthy

83% live in families with at least one adult worker

44% are single adults who are not parents

47% have incomes below 200% FPL (approx. $40,000 for a family of 4) 35% of uninsured have family incomes above 300% of the poverty level (approx.

$60,000 for a family of four in 2005)

A significant number of the uninsured are either on Medicaid/ MCHIP (the “Medicaid undercount”) or are eligible

27% are not US citizens

Uninsured rates are higher in our Hispanic (39%) and black (19%) populations. This primarily reflects income differences, except in the Hispanic population

Small businesses have a disproportionate share of the uninsured workers

Why This Matters

There is a well-documented connection between insurance coverage and access to care and health: The uninsured are more likely to go without needed care

and have poorer health outcomes that those with insurance. Care is often provided in the most expensive setting with

the least continuity of care – the Emergency Department. We all pay the cost of caring for Marylanders who either

cannot afford or choose not to get health insurance. In Maryland, premiums for family coverage were estimated to be

$948 higher because of uncompensated care in 2005. (FamiliesUSA) Hospital Uncompensated Care - $800 million a year in rate adjustments

Caveat: Most of the uncompensated care is bad debt Caveat: The Feds have already contributed to the fund through Medicare and

Medicaid rates

The Emergency Department as Safety Net Care

21.7%

18.8%

18.6%

21.3%

19.1%

18.9%

17.7%

20.7%

10.3%11.0%

NoInsurance

PrivateHMO

Commercial

Medicaid

Medicare

Paym

ent S

ourc

e

Non-Emergent

Emergent, PCTreatable

Source: Maryland Health Care Commission

A substantial proportion of A substantial proportion of Maryland ED visits are Maryland ED visits are

treatable without an ED visit treatable without an ED visit - - at least in theoryat least in theory

% of population

% of ED visits

Medicare 11 12

Medicaid 9 21

Private insurance

64 46

No insurance

14 22

Individuals with Medicaid and Individuals with Medicaid and the uninsured are more likely to the uninsured are more likely to

use the ED use the ED

Senate Bill 62007 Special Session

Expands Medicaid eligibility to cover parents with incomes below 116% FPL effective July 1, 2008

Gradually expands Medicaid services for other adults below 116% FPL, subject to funding

Creates the Small Employer Health Benefit Premium Subsidy Program

Net result: 100,000 fewer uninsured

SB6 Changes in Public Coveragebeginning 7/1/08

Note: This chart is for illustrative purposes only. Each coverage group has specific eligibility and some asset requirements, which are not shown.

200

100

300

133

40

Age 65 and Over+

19610 Parents or disabled age 19 to 64

250

PW

185

Poverty Level:1 person = $10,2102 persons =$13,6904 persons = $20,650

As of 1/24/2007

MCHP Premium

MCHP

Medicaid

Primary Adult Care Program – 116% FPL

Pregnant Women

Medicare

300

ParentsAll adults

Small Business Health Benefit Premium Subsidy

Maryland Health Care Commission

In consultation with:Department of Health and Mental HygieneMaryland Insurance Administration

Subsidy Design Team Subsidy Design Team

Maryland Health Care CommissionMaryland Health Care CommissionBruce Kozlowski, Director, Center for Health Care Financing and PolicyBruce Kozlowski, Director, Center for Health Care Financing and PolicyBen Steffen, Director, Center for Information Services and AnalysisBen Steffen, Director, Center for Information Services and AnalysisJanet Ennis, Chief, Small Group MarketJanet Ennis, Chief, Small Group MarketNicole Stallings, Director, Government RelationsNicole Stallings, Director, Government RelationsMel Franklin, AG’s officeMel Franklin, AG’s officePlus: Administration, AG, Contracting, RegulationsPlus: Administration, AG, Contracting, Regulations

Other State Government AgenciesOther State Government AgenciesDHMH (design, implementation, financial management of SF)DHMH (design, implementation, financial management of SF)MIA (wellness, regulations)MIA (wellness, regulations)HSCRC (regulations)HSCRC (regulations)Comptroller (subsidy payments, auditing family income)Comptroller (subsidy payments, auditing family income)DLLR (quarterly wage reports as audit check, information dissemination)DLLR (quarterly wage reports as audit check, information dissemination)DBM (financial management and budget)DBM (financial management and budget)DBED (information dissemination)DBED (information dissemination)

The Governor and AdministrationThe Governor and AdministrationThe General AssemblyThe General Assembly

Members of the Health and Government Operations CommitteeMembers of the Health and Government Operations CommitteeMembers of the Senate Finance CommitteeMembers of the Senate Finance Committee

Consultants - Academy Health / RWJConsultants - Academy Health / RWJJonathan Gruber, MIT – health economics consultationJonathan Gruber, MIT – health economics consultationMercer – John Welch – Section 125 plans and design adviceMercer – John Welch – Section 125 plans and design advice

CarriersCarriersThird-Party AdministratorsThird-Party AdministratorsBrokers/agentsBrokers/agentsSmall business ownersSmall business ownersSmall business associations (NFIB, Chamber, Retailers and Restaurant Assn)Small business associations (NFIB, Chamber, Retailers and Restaurant Assn)

Small Employer Health Benefit Plan Premium Small Employer Health Benefit Plan Premium Subsidy ProgramSubsidy Program

The purposes of the program are to:

provide an incentive for small employers to offer and maintain health insurance for their employees;

help employees of small employers afford health insurance premium contributions;

promote access to health care services, particularly preventive health care services that might reduce the need for emergency room care and other acute care services; and

reduce uncompensated care in hospitals and other health care settings.

Small Employer Health Benefit Plan Premium Subsidy Program:

Eligibility Requirements in SB 6

At the time of initial application, the business meets the following requirements:

The business has at least 2 and no more than 9 eligible employees

30 or more hrs/wk The business has not offered insurance to its employees in

the most recent 12 months Corollary: Must have been actively engaged in business for 12

months The coverage purchased must have a wellness benefit The average wage of the eligible employees is less than an

amount determined by the Commission

Design fundamentals:Design fundamentals:

The program should have stability and continuity– Eligibility should not disappear or phase out unless firm grows and prospers– There should be no “cliffs” – abrupt changes in subsidy as firm grows or prospers

The program should be simple and easily explained– Wages rather than income– Average wage rather than median– Subsidy applies equally to all employees – no separate employee income test except

for family coverage

The program must be affordable and “efficient” in an economic sense– Requires targeting a subset of small businesses– Requires targeting the program to employers not currently offering insurance – a

tradeoff between efficiency and fairness

The program should be designed to:– Provide employers with choices of plans– Simplify administration and keep administrative costs low– Maintain established business relationships, processes, and incentives– Assure that subsidies are seamlessly integrated into routine billing and payroll

deductions– Assure effective auditing of the subsidy– Minimize bureaucracy while preventing fraud and abuse

Implications for Program Administration

Subsidize a variety of current small group market health plans rather than contract with a single carrier

Administer the subsidies through premium reductions, not through checks to employers and employees

Basic agreement is with the carriers, who are free to designate fiscal agents to handle administration and billing

The subsidy is paid to the carrier

Total subsidy is passed through to the employer as a reduced group premium

The subsidy is shared between employer and employee in proportion to the amount each has contributed toward the premium

Employers in turn must agree to pass through the employee’s share of the subsidy in the form of lower payroll deductions for health insurance

How will the subsidy be delivered?Current design, subject to change

Apply for insurance and subsidy Include info re wages and existing coverage for all employees

MHCC registry confirms

•The subsidy rate for each type of coverage (indiv, +children, +spouse, family)

•The total premium subsidy amount passed through to the employer

•The subsidy to be passed through to each employee through lower payroll deductions

Carrier sends MHCC info re all payments received, all persons

insured

Carrier bills for following month

Employer pays by 1st of month

Comptroller pays by 1st of month

Bill employer for premium -

subsidy

Bill MHCC for subsidies

MHCC compares with registry

Any subsidy payment not matched by a corresponding employer payment will be deducted from the next payment to the

carrier

Application Monthly payment and reconciliation

Employer establishes Section 125 plan

Employer begins payroll deductions for employee’s share of premium

How Will the Subsidy Be Calculated?How Will the Subsidy Be Calculated?Design based on models developed by Jonathan GruberDesign based on models developed by Jonathan GruberConsultation supported by AcademyHealth / RWJ grantConsultation supported by AcademyHealth / RWJ grant

Amount of premium subsidy Amount of premium subsidy ((proposed - subject to final regulations)proposed - subject to final regulations)

SB6: Either 50% of the premium or an amount set by SB6: Either 50% of the premium or an amount set by the Commission, whichever is lowerthe Commission, whichever is lower

Proposed “limiting amounts” for FY2009 Proposed “limiting amounts” for FY2009 Based on recent HMO premiums “as purchased” in SGMBased on recent HMO premiums “as purchased” in SGM

Average Average wagewage

EmployeEmployee onlye only

EmployeEmployee + childe + child

EmployeEmployee + e +

spousespouse

FamilyFamily

<$25,00<$25,0000

$2000$2000 $3000$3000 $4000$4000 $5000$5000

$30,000$30,000 $1600$1600 $2400$2400 $3200$3200 $4000$4000

$35,000$35,000 $1200$1200 $1800$1800 $2400$2400 $3000$3000

$40,000$40,000 $800$800 $1200$1200 $1600$1600 $2000$2000

$45,000$45,000 $400$400 $600$600 $800$800 $1000$1000

$50,000$50,000 $0$0 $0$0 $0$0 $0$0

How Will the Average Wage Be Calculated?How Will the Average Wage Be Calculated?

Information provided by employerInformation provided by employer Hourly x avg. hours/wk x 52Hourly x avg. hours/wk x 52 Add weekly tip income x 52Add weekly tip income x 52 Annual salaryAnnual salary

The owner/partner dilemmaThe owner/partner dilemma Owner’s draw income from the company in a variety of ways, not Owner’s draw income from the company in a variety of ways, not

just wages, so it’s necessary to use the owner’s income if he/she just wages, so it’s necessary to use the owner’s income if he/she works more than 30 hours a week at the business and thus is works more than 30 hours a week at the business and thus is eligible for coverage.eligible for coverage.

The goals are to assist the low wage small business and to get The goals are to assist the low wage small business and to get employees insuredemployees insured

An owner’s high income should not immediately disqualify a low-An owner’s high income should not immediately disqualify a low-wage firmwage firm

Resolution:Resolution: Use the average wage of the firmUse the average wage of the firm Count only the first $60,000 of each owner’s/partner’s income in Count only the first $60,000 of each owner’s/partner’s income in

figuring the average wage of the firmfiguring the average wage of the firm If the owner’s AGI is below $60,000, use the AGI instead If the owner’s AGI is below $60,000, use the AGI instead

Examples of Average Wage CalculationsExamples of Average Wage Calculations

$120,00$120,0000

$60,000$60,000 $60,000$60,000 $35,000$35,000

$32,000$32,000 $32,000$32,000 $60,000$60,000 $32,000$32,000

$26,000$26,000 $26,000$26,000 $60,000$60,000 $26,000$26,000

$18,000$18,000 $18,000$18,000 $20,000$20,000 $18,000$18,000

$17,000$17,000 $17,000$17,000 $17,000$17,000

AverageAverage $43,200$43,200 $31,200$31,200 $50,000$50,000 $25,600$25,600

Subsidy – Subsidy – empl. empl. onlyonly

$540$540 $1,560$1,560 $0$0 $1,960$1,960

The Special Case of Health Savings AccountsThe Special Case of Health Savings Accounts$35,400

max OOP reached

$2700 deductibl

e

$15,450 max OOP

reached

$2700 deductible

Preventive care

$2700 deductibl

eRemainder of deductible -

$1200

20% co-ins

Employer contribution to HSA

- $1500

Standard HMO

$3900 premium $1950 subsidy

High-deductible HMO with HSA $2400 premium $1200 subsidy

HD HMO/HSA - employer contributes premium savings to

HSA

Preventive care

$15,450 max OOP

reached

$2400 premium + $1500 HSA $1950

subsidy

20% co-ins

20% co-ins

Preventive care

= Patient OOP

Incr

easi

ng h

ealt

h e

xpen

dit

ure

s

=>

The Special Case of Family CoverageThe Special Case of Family Coverage

We expect the great majority of coverage to be employee We expect the great majority of coverage to be employee onlyonly

Spousal coverage is relatively expensive, in part due to risk Spousal coverage is relatively expensive, in part due to risk selectionselection

Employers subsidize family coverage less generously, if at allEmployers subsidize family coverage less generously, if at all

Nonetheless, subsidizing dependent coverage would be as Nonetheless, subsidizing dependent coverage would be as efficient as the employee subsidy, and we wanted to efficient as the employee subsidy, and we wanted to encourage coverage of the entire family.encourage coverage of the entire family.

Note that some of the children are MCHIP eligible Note that some of the children are MCHIP eligible

If eligibility were solely wage-based, a low-wage spouse If eligibility were solely wage-based, a low-wage spouse could get subsidized coverage for a high income familycould get subsidized coverage for a high income family

Therefore, employees will have to attest to having a family Therefore, employees will have to attest to having a family income below $75,000income below $75,000* * to be eligible for a subsidy to be eligible for a subsidy for the for the dependent coveragedependent coverage

Employer roleEmployer role

Select an agent/broker, who will handle the subsidy applicationSelect an agent/broker, who will handle the subsidy application Provide information about the business and its employeesProvide information about the business and its employees

Quarterly wage reports and current wages/salariesQuarterly wage reports and current wages/salaries Any previous health insurance offered by the businessAny previous health insurance offered by the business

Select a health plan with a wellness benefitSelect a health plan with a wellness benefit We anticipate that both HMO and PPO plans will be available, and that some will We anticipate that both HMO and PPO plans will be available, and that some will

be high-deductible plans with HSAsbe high-deductible plans with HSAs Select a percentage of the premium as the employer contributionSelect a percentage of the premium as the employer contribution

Employer contributions toward dependent coverage are allowed and are Employer contributions toward dependent coverage are allowed and are subsidized, but are not requiredsubsidized, but are not required

If an HSA plan is chosen, decide whether to contribute premium savings to the If an HSA plan is chosen, decide whether to contribute premium savings to the HSA (employer contributions to the HSA are eligible for the subsidy)HSA (employer contributions to the HSA are eligible for the subsidy)

Contribution should be high enough to achieve the 75% participation rate required Contribution should be high enough to achieve the 75% participation rate required by insurersby insurers

The employer receives the entire subsidy in the form of reduced premiumsThe employer receives the entire subsidy in the form of reduced premiums the State pays the subsidy to the insurance companythe State pays the subsidy to the insurance company the employee’s share of the subsidy is passed through in the form of reduced the employee’s share of the subsidy is passed through in the form of reduced

payroll deductionspayroll deductions The employer pledges to establish a Section 125 planThe employer pledges to establish a Section 125 plan

Employer attestation (draft)Employer attestation (draft)

Employee Form

Choice of coverage Employee only Employee plus children, or spouse, or both

Agreement to payroll withholding under Section 125 Information about public or private health insurance coverage

within the last three months to assess crowd-out to document effect of program on uncompensated care

If dependent coverage is chosen, signed attestation that family Adjusted Gross Income (AGI) < $75,000

If single, AGI from the individual return If married filing separately, combine the AGI’s of the separate returns If married filing jointly, AGI from the joint return

Broker/Agent

Vital to the success of small group programs Provide advice and education for the employer

HSA’s and HDHP’s, Section 125 plans pose special educational challenges Gather information necessary for carrier and subsidy

applications, obtain quotes and subsidy estimates, assist employer decision-making

Submit applications to subsidy program and carrier Subsidy submission may also be handled by the carrier or a TPA Broker/Agent attests that:

To the best of their knowledge, employer is eligible for the subsidy Wages and number of full-time employees reported on the subsidy application

are consistent with the employer’s Quarterly Wage Report Health benefit plan includes a wellness benefit

Provide employee education, HR support, assistance in claims resolution

The Wellness BenefitThe Wellness Benefit

The wellness benefit is part of the carrier’s benefit design, not a The wellness benefit is part of the carrier’s benefit design, not a stand-alone employer-sponsored wellness program.stand-alone employer-sponsored wellness program.

A qualifying wellness benefit must include:A qualifying wellness benefit must include:

Health Risk Assessment (HRA)Health Risk Assessment (HRA)

Education based on the HRA responsesEducation based on the HRA responses

Financial incentive for prevention, health promotion, or Financial incentive for prevention, health promotion, or disease managementdisease management

Direct financial rewardDirect financial reward Reduced cost sharingReduced cost sharing

Section 125 Premium Only PlanSection 125 Premium Only Plan

Allows employee premium payments to be excluded from Allows employee premium payments to be excluded from both income tax and FICA taxboth income tax and FICA tax

Substantial benefit to employees who pay taxesSubstantial benefit to employees who pay taxes Modest benefit to employers (no FICA tax on employee Modest benefit to employers (no FICA tax on employee

premium payments)premium payments) Simple to establish, no annual reportingSimple to establish, no annual reporting

Cost will be between $0 and $200 – easily recaptured through Cost will be between $0 and $200 – easily recaptured through FICA savingsFICA savings

Establish plan and notify employeesEstablish plan and notify employees No filing of documents or reports required No filing of documents or reports required

Keep plan document on fileKeep plan document on file Review the plan if the Federal law changesReview the plan if the Federal law changes

Make adjustments to payroll Make adjustments to payroll Contract with Mercer Contract with Mercer

Materials, PowerPoint, community meetingsMaterials, PowerPoint, community meetings Carriers and TPAs may provide as additional benefitCarriers and TPAs may provide as additional benefit

Expected questions:Expected questions:

Is this subsidy time-limited?Is this subsidy time-limited? No – the Governor and the General Assembly intended No – the Governor and the General Assembly intended

this to be an ongoing programthis to be an ongoing program

What happens if the average wage of my business What happens if the average wage of my business increases?increases?

Subsidies will be adjusted Subsidies will be adjusted annually at policy renewalannually at policy renewal to reflect the to reflect the firm’s then current average wagefirm’s then current average wage

The income limits in the subsidy table will be adjusted annually for The income limits in the subsidy table will be adjusted annually for inflationinflation

The gradual phase-out from $25,000 to $50,000 assures that the The gradual phase-out from $25,000 to $50,000 assures that the subsidy phases out gradually as the firm grows and prosperssubsidy phases out gradually as the firm grows and prospers

Expected questions:Expected questions:

What happens if my firm grows in size?What happens if my firm grows in size? Individual firms initially qualify as program participants Individual firms initially qualify as program participants

based on their size based on their size at the time of applicationat the time of application As long as the program as a whole is not capped, new As long as the program as a whole is not capped, new

employees are eligible for the subsidy. employees are eligible for the subsidy. During the current policy year, the business pays the same During the current policy year, the business pays the same

per employee premium and receives the same per per employee premium and receives the same per employee subsidy that apply to other employees.employee subsidy that apply to other employees.

At the time of policy renewalAt the time of policy renewal:: The firm’s age distribution will be used to determine a The firm’s age distribution will be used to determine a

premium for the next year.premium for the next year. The firm’s average wage will be recalculated and used to The firm’s average wage will be recalculated and used to

determine the maximum subsidy for the next yeardetermine the maximum subsidy for the next year If the firm has ten or more employees, a further If the firm has ten or more employees, a further

adjustment will be made based on the number of adjustment will be made based on the number of employees, so that the subsidy phases out between 10 and employees, so that the subsidy phases out between 10 and 20 employees.20 employees.

Expected questions:Expected questions:

What happens when the program reaches its What happens when the program reaches its maximum sustainable size?maximum sustainable size?

The subsidy program will be closed to new businessesThe subsidy program will be closed to new businesses Although the proposed regulations allow the Commission also to Although the proposed regulations allow the Commission also to

close the program to new employees of participating businesses, close the program to new employees of participating businesses, the intent is to close the program only to new businesses, while the intent is to close the program only to new businesses, while allowing already participating businesses to provide subsidized allowing already participating businesses to provide subsidized coverage to additional employees coverage to additional employees

When does the program start?When does the program start? Subsidized coverage starts October 1, 2008Subsidized coverage starts October 1, 2008 Carriers or their financial agents may enter applications and Carriers or their financial agents may enter applications and

confirm subsidies in the Registry beginning in early to mid-confirm subsidies in the Registry beginning in early to mid-SeptemberSeptember

We turn to you as our consultants who know small businesses:

Is the subsidy design reasonably clear? How will small businesses respond? What are the main concerns that we need to address head-

on? What are the best ways of communicating with these small

employers about the subsidy? Presentations at meetings Mailings, newsletters, newspaper articles Web site with information about likely premiums and tools to

calculate likely subsidy amounts Other innovative ideas?

______________

We plan to make presentations throughout the state and will hold at least one information and training session for brokers and agents at the Commission during the summer

Thank you….

http://mhcc.maryland.gov Contact: Janet Ennis jennis@mhcc.state.md.us