State's health benefits agency running out of money

Yahoo

17-04-2025

BOSTON (SHNS) – The state agency that oversees health insurance for 460,000 public employees, retirees and their dependents is on track to run out of money to pay claims on May 12, a full seven weeks before the end of the fiscal year.
During a briefing to Group Insurance Commission members Thursday, Executive Director Matthew Veno said rising provider prices and increased utilization of prescription benefits, including for GLP-1 weight loss drugs, had caused the commission to run an average $20 million monthly deficit this fiscal year.
With the fiscal year set to end June 30, the commission is counting on taxpayers to cover its deficit and has a $240 million appropriation request pending before the Legislature.
The appropriation was the largest single request in a $756 million spending bill Gov. Maura Healey filed in early April.
The House Ways and Means Committee released its fiscal 2026 annual budget Wednesday, and Veno expressed hope Thursday that the panel will quickly turn attention to the supplemental budget. He said he was working with Healey's team to make sure lawmakers understand 'the urgency of moving this legislation.'
'What we want to do is avoid disruption to our members, our health plans and to the providers that rely on our prompt payment of claims,' he said. 'And we are likewise in the process of meeting with our health plans to make sure that we're prepared to manage any disruption that may come along our way if there's delayed action.'
While predicting timetables for legislative action in Massachusetts is perilous, Veno said he believed that it was 'unlikely that the supplemental budget will not be enacted in a timely manner.'
'But it is certainly a cause on my part for concern and focus since by our current projections and our current appropriation is sufficient to make claims only through the 12th of May 2025,' he added.
Commission members had no questions for Veno about the deficit, apart from a Bobbi Kaplan inquiry about whether the GIC might need to adjust its fiscal 2026 budget request to reflect the higher fiscal 2025 costs. Veno said no adjustment is necessary.
'While we have been consistently running a deficiency, it's been pretty consistent. So we were able to build an FY '26 budget that reflects those trends,' he said.
There's been steady growth in the major state spending account in recent years, adding pressure in the overall state budget and creating another touchpoint for those who believe stronger action is needed to address health-related costs.
The GIC's 'plan premium and costs' are projected at $2.16 billion for fiscal 2025 and Healey requested a $2.4 billion allocation for fiscal 2026, a funding level also recommended by the House Ways and Means Committee. Expenses from the account totaled $1.83 billion in fiscal 2022, according to state finance documents.
The GIC provides health insurance to state employees and retirees and their dependents and survivors. It has 280,000 subscribers and 460,000 members.
In January, Veno flagged the agency's budget shortfalls as a going concern.
'This is the largest variance that we've seen in at least a decade, and this is consistent across all of our plans, and is driven primarily by rising provider prices and a couple of other topics,' he said at the time. He added, 'We don't know where this is going to head. My concern is that it is a persistent and steady trend going forward.'
The agency has a 'good list of candidates' for its open chief financial officer position, Veno said, an the annual enrollment process is 'going smoothly' with policy holders shopping around given increasing premiums. The commission also plans to offer a report in May on out-of-pocket spending trends.
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