Individual Responsibility

Under state health care reform enacted in 2006, all Massachusetts residents must have health coverage that is considered “creditable”. As proof of coverage, carriers, TPAs, or employers must issue a written statement to each covered state resident by January 31st each year on a Form 1099-HC. The website for the Massachusetts Department of Revenue provides Instructions for Electronic Filing of Form 1099-HC and a sample paper form. Use of the sample form is not required, as long as individuals receive a written document that includes the names and tax IDs of the insurance company and covered family members as well as the effective dates of coverage. More information on health care reform for individuals can be found on the website.

Note that the Massachusetts “creditable” coverage requirement is slightly different from coverage mandated by the Affordable Care Act (ACA).

Employer Fees & Reporting

If you are an employer with at least 6 employees working in Massachusetts, the following provisions apply:

Until 2013, employers were required to make “fair share contributions” towards employee health coverage and report such information on the Health Insurance Responsibility Disclosure (HIRD) form. These provisions were repealed once the ACA’s employer shared responsibility provision was enacted.

In 2014, Massachusetts created the “Employer Medical Assistance Contribution” (EMAC) fee. This fee is paid by employers to fund state health care initiatives, such as Medicaid. The EMAC fees are paid through the employer’s state unemployment reporting.

In 2017, Massachusetts passed a new law effective for 2018 and 2019. This law:

  • Reduced scheduled increases in the employer’s unemployment rate;
  • Increased the EMAC fee from a maximum of $51 to $77 per employee per year; and
  • Added an EMAC Supplement, which is an employer penalty of up to $750 per year for each non-disabled employee that receives state-subsidized health coverage (through Medicaid or the state’s exchange).

Note that if the employer offers affordable, ACA-compliant medical coverage, employees technically should not qualify for subsidized coverage through the state exchange. However, employees on Medicaid can trigger the EMAC Supplement because the state’s Medicaid eligibility requirements are only based on the employee’s income, and not the employer’s offer of medical coverage.

Massachusetts is also reinstating an updated version of employer reporting. The state will collect information from employers on health insurance offerings to allow the state Medicaid program to identify individuals who are eligible for state premium assistance. The new employer reporting requirement will be completed online and is scheduled to be available in late 2018.