Massachusetts budget officials told the Group Insurance Commission on November 1 that federal policy changes and persistent health‑care cost growth are constraining the state’s fiscal outlook, prompting the commission to examine a wide range of measures to keep GIC coverage affordable to the Commonwealth and members.

"We have about $1,300,000,000 in federal budget impacts in FY '26" and "OB 3 is expected to cost the state about $664,000,000 in lost tax revenue in fiscal year 26," Chris Marino, Assistant Secretary for Budget at the Executive Office for Administration and Finance, told commissioners. Marino said health‑care expenditures are growing at rates far above revenue growth and pointed to $240 million in supplemental FY25 funding for GIC and roughly $2 billion sought for MassHealth as evidence of the pressure.

With that context, GIC Executive Director Matt walked commissioners through four buckets of levers within the commission’s statutory authority: participation audits (eligibility reviews), plan design (member cost sharing), population‑health and carrier accountability tools, and premium contribution changes. Staff emphasized the trade‑offs between Commonwealth affordability and member affordability and requested commissioner input on priorities and further data requests to model impacts.

Options presented included modest member cost‑sharing increases (for example, raising urgent‑care co‑pays from $20 to $30 and ER co‑pays toward $150), reinstating telehealth mental‑health co‑pays that had been waived during COVID, rolling back some expanded hearing‑aid coverage for adults, increasing commercial deductibles, and revisiting the GIC’s coverage of GLP‑1 drugs for weight loss. Staff flagged GLP‑1 coverage as having the largest potential premium impact but also noted equity concerns if coverage were eliminated.

Staff also described a CVS‑administered program called Prudent Rx intended to capture manufacturer copay assistance at the point of sale so the plan can offset drug spend. That program requires members to enroll in manufacturer assistance programs (yielding a 0 copay); if members do not enroll, the plan indicated they could face significant liability for the drug cost unless staff manage enrollment and communications closely.

A significant non‑member‑facing option staff suggested was implementing a uniform methodology for carrier payment to out‑of‑network providers to reduce variability and realize savings; staff said paired protections would be modeled to preserve access where necessary. Commissioners asked staff to present comparable state models (Maryland, Oregon, Vermont and others were mentioned) for reference‑based pricing and to provide detailed utilization and fiscal modeling (urgent care/ER utilization, estimated savings and the distributional impacts across income and demographic groups).

Several commissioners urged caution about member impacts and asked staff to model equity consequences: who would be most affected by cost‑sharing increases or benefit rollbacks, potential enrollment losses in voluntary programs (e.g., Vida/Vida Health transitions), and how premium‑split changes would affect surviving spouses and dependents. Staff committed to preparing trend graphs, utilization data, extrapolated overpayment estimates from audit work, and modeled dollar impacts for the commission’s December meeting.

No formal decisions or votes were taken; commissioners directed staff to return with comparative benchmarking, concrete fiscal estimates, and proposals that include equity impact analysis and implementation safeguards. The commission will continue the discussion in December as staff refines modeling and options in light of the state’s budget planning cycle.