MA S859

Creates a state-run public health insurance option administered through the Massachusetts Commonwealth Connector, available to eligible individuals not offered subsidized employer coverage (50+ employees) and to small groups (1-50 employees) by January 1, 2027, and large groups (51+ employees) by July 1, 2027

Provider payment rates will be based on Medicare Parts A and B rates, with the Connector Board authorized to make adjustments to maintain adequate provider networks

Healthcare providers participating in Medicare are automatically enrolled in the public option but may opt out without penalty through an annual enrollment process

Establishes a Public Health Insurance Option Trust Fund to finance plan operations, with premiums set at levels sufficient to cover health benefits and administrative costs

Creates a risk adjustment program requiring the Commissioner of Insurance to assess health plans with lower-risk enrollees and provide payments to plans with higher-risk enrollees, excluding ERISA self-insured plans