The demands upon outreach workers are higher than ever while the resources available are limited. As one HAN member put it: "It’s worse than I’ve ever seen, and we have to be more creative."
Systems challenges
Both unemployed people and outreach workers continue to have difficulties interfacing with the Medical Security Program (MSP). Mostly, it is the time spent waiting for the application to be processed, and the anxiety this brings; a HAN member mentioned a client whose wife has been hospitalized while the application is pending. It is often impossible to get through to an MSP representative over the phone.
Other employees whose hours have been cut no longer have access to affordable insurance because they are participating in a workshare program with unemployment instead of receiving traditional benefits. They are not eligible for MSP or the new federal COBRA subsidy.
One outreach worker who helped a client apply simultaneously to MSP and the Health Safety Net reported that this backfired. When she submitted the application through the Virtual Gateway, the client was approved for Commonwealth Care, though they were not eligible. He was then denied MSP because he had CommCare.
Evidently Commonwealth Care members are dropping their coverage because they can’t afford the premiums. Many people don’t realize that if they lose Commonwealth Care coverage for not paying premiums, they also lose access to the Health Safety Net. Outreach workers are educating members that it is better to set up a payment plan and/or select a lower-cost plan when possible than to lose coverage.
Some student clients are opting out of their inadequate school-based insurance, choosing to pay the mandate penalty instead; outreach workers are letting them know about the possible consequences of remaining uninsured.
Resources in Western Massachusetts
A new student group at UMass is engaging students with community outreach and health access issues. The Community Health Outreach Coalition (CHOC) is interested in helping students connect to outreach workers and volunteer with outreach & enrollment organizations. For more information, contact Olga Deshchenko: odeshchenko[at]gmail[dot]com.
Advocates are still helping elders and people with disabilities exercise their right to live in the community instead of nursing homes. In the Springfield area, Greater Springfield Senior Services (413-781-8800) works with families to discuss any and all alternatives to nursing home placements. The Stavros Center for Independent Living is also a resource.
Stavros has also been working with clients who have received reductions in the Personal Care Attendant (PCA) hours they are allotted by MassHealth. Anyone who is in this situation can call Stavros at 1-800-804-1899 for information and advocacy resources.
Live Well Springfield is working on a web-based resource and referral guide available to the broader Western Massachusetts community. They are trying to include as many organizations in Western Mass as possible; anyone with ideas can contact Debbie Kinney (see our attendance list - PDF).
We were happy to welcome Amy Slemmer, Health Care For All’s new Executive Director. An attorney, Amy came to Massachusetts from Washington, D.C., after serving as an Executive Officer at the American Red Cross. She has much experience doing policy and advocacy work on health care issues, among others.
Amy outlined some of the bills HCFA is currently working hard to pass. High on the list is restoring funding for outreach and enrollment grants. Improving student health plans is another priority, along with continuing initial successes in bringing transparency to the relationship between drug companies and prescribers.
Health care cost and quality are now major concerns for everyone. To increase revenue and fairness, HCFA is working to have employers who are receiving the significant public benefits of health care reform provide more money to the system. HCFA is also looking into ways to reform how we pay providers – specifically into alternatives to the fee-for-service model – as well as quality measures. As the state’s Cost and Quality Council and Payment Reform Coalition do their work, HCFA will "translate" information and make it available on their website.
HCFA will also be pursuing other priorities:
Amy is hoping to add additional counselors to HCFA’s Helpline. They expect to take 40,000 calls this year, and time spent on each call is lengthening.
Meg offered news about pending changes to the Commonwealth Care exceptions process that should make it simpler. Commonwealth Care rules will soon follow MassHealth rules: if you work less than 100 hours per month, you will not be assumed to have coverage from your employer. The exception form itself is also being revised to include a box to check whether or not you are offered Employer-Sponsored Insurance (ESI). When access to ESI is reported by current recipients, they will receive an exception notice with 30 days to respond during which coverage is pending.
An anticipated Contributory Plan for small employers was introduced to W-HAN members by Paul Wingle, Commonwealth Choice Outreach Director. Joan Fallon, Communications Officer for the Connector, brought us positive statistics on the progress of health care reform.
Commonwealth Choice is pilot testing its health insurance option for small employers, the Contributory Plan. This option will give employers a way to sponsor or subsidize their employees’ health benefits through the web. The program is only available to groups of fifty or fewer employees. It is being piloted by 30 pilot brokers trained by Health Connector staff and 25 employers. Once the pilot is completed, the plan will go live.
Small employers often do not have time to do lots of comparing and negotiating for insurance contracts; nor do they have lots of leverage. The new Contributory Plan aims to provide small businesses with access to the kind of health insurance choices that are available to large employers. Small businesses will be able to choose from a number of brand-name plans and pay a fixed contribution toward the cost.
How it will work
When pilot testing is over and the Contributory Plan becomes widely available, employers will be able to choose a "Benchmark" plan and set a contribution level (50% minimum for an individual and 25% minimum for dependents). Once the decisions are made and the employer applies, an Employer ID # is generated.
Employees can then use the Employer ID # to shop for health insurance plans. The employees can select the "Benchmark Plan" the employer has chosen or carry the employer’s contribution to a different Commonwealth Choice plan. The employees can buy up or down within the tier (gold, silver or bronze) the employer has chosen. As a result, the employees have more choice and flexibility in their health coverage options. The employers benefit from cost control, simplified billing and support.
In the Pioneer Valley and Western Massachusetts, small businesses will have a minimum of three to four choices of insurance carriers. The Connector is also working with carriers to build more networks.
Employees do not have to shop through a broker. Once employees log in with the Employer ID #, they will see the benefit tier that’s available through their employer and can choose a plan that is best for them. Simon Muil of the Insurance Partnership pointed out that because it is employer-sponsored insurance, it is compatible with the Insurance Partnership.
Once it is ready to go live, the Connector aims to work with network grantees on outreach and enrollment initiatives to raise awareness about the new plan.
The Connector wants to avoid overburdening community health workers with learning to navigate a new product. The goal is to partner with brokers at the community level, so they can provide direct enrollment, while health workers can serve as the referral point in the community.
Health Care Reform Updates
Joan Fallon of the Connector updated us on the positive achievements of health care reform, noting that without community health workers, the historic rate of 97.4% of insured citizens in MA would not be possible:
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