The situation was all too familiar: A young woman and her father met with one of our Community Outreach Workers and asked how to sign up for health insurance. A quick check in My Account Page (MAP) found that her MassHealth Essential had ended mid-month because she had started a new part-time job. MAP also showed she was already Commonwealth Care eligible. The Outreach Worker explained how to enroll in Commonwealth Care and all of the benefits it would provide starting next month.
"Well, the problem is that she’s a heroin addict," the father said. "Her rehab clinic checks her insurance every day and won’t help her out until she gets her insurance back."
Manet Community Health Center’s five locations are on the South Shore which, like much of the rest of the Commonwealth, is in the midst of a heroin epidemic. In two consecutive Regional Dialogues, Massachusetts Public Health Commissioner John Auerbach highlighted the high rate of opioid-related emergency department visits on the South Shore, with particularly alarming numbers in Weymouth and Quincy. The Quincy Patriot Ledger published a series of articles about heroin abuse called "Wasted Youth," stories from which were featured in an A&E television special.
Recovering addicts are suffering in the familiar gap between MassHealth and Commonwealth Care. Although a client’s MassHealth coverage may terminate at any point in the month, Commonwealth Care only begins at the first of each month. Any delay in the Commonwealth Care enrollment process can extend the gap in coverage for another month (e.g., sometimes MassHealth recipients don’t realize they have been approved for Commonwealth Care and miss the deadline for enrollment). Unless the treatment center is connected to the Health Safety Net, clients must pay out of pocket until their Commonwealth Care coverage begins.
The case of the young woman described above is pretty typical. The client had a heroin addiction and was unemployed for more than 12 months. Once she applied for MassHealth, she was able to enter a methadone clinic. Halfway through the course of her treatment, she went back to work part-time in order to earn money and help her re-entry into society. That small amount of income triggered a disenrollment from MassHealth and a change to Commonwealth Care, effectively ending the treatment plan that had been progressing so well. As the client explained to our Outreach Worker, once a patient of a methadone clinic is uninsured and unable to pay out of pocket for treatment, the clinic immediately begins detoxification – though methadone withdrawal is a daunting prospect for any recovering addict.
Nobody wins when addicts seeking treatment are without insurance coverage. Let’s hope that a policy change allows people to stay on the path to recovery.
Help
Thanks for your comments, Vicky and Karen.
Two different approaches to the problem. Most of you know Vicky, or at least her work, and I encourage you to contact her & MLRI with questions. Karen Brown, from WFCR, attended a western HAN meeting this fall and asked me if it would be okay for her to post a request...I said certainly, and that I'd remind you all of who she is and her work. She's good, and understands the importance of outreach, enrollment and the difficulties you all face.
Meg
Getting these stories out there
I am a public radio reporter in Western Massachusetts (for WFCR and NPR), and I'm covering these issues while on a Kaiser Foundation fellowship. I would love to hear from advocates or providers or consumers with stories like this -- to show how the "gaps" in Masshealth and Comm Care are affecting people (regarding recovery and other issues). In general, I am trying to gather examples on what's working in health reform and what's not. You can contact me with any story suggestions, contacts, or referrals by email: kbrown@wfcr.org. You can also leave a voicemail at: 413-545-4274.
I am especially interested in getting in touch with the people who are directly affected by health reform -- either positively or negatively.
Many thanks,
Karen Brown
2008-09 Kaiser Media Fellow
Reporter, WFCR
Contributor, NPR
kbrown@wfcr.org
Recovery -reply
This post makes a convincing case for a policy change, unfortunately the "gap" issue has not gotten much attention from policy makers to date.
Until we get a policy fix, I strongly encourage outreach workers to refer cases like this one for legal assistance. You can find the legal aid office for the town where your patients/clients live at http://www.masslegalhelp.org & there is also Health Law Advocates.
Could a legal advocate have helped? Maybe. Sometimes the MassHealth termination is incorrect either because someone is still eligible for the same program (e.g.intermittent employment doesn't count in Essential)or because another MassHealth program (like MassHealth based on HIV status or disability) has not been considered. Anyone terminated from MassHealth gets an advance notice & if they appeal before the closing date can continue getting benefits pending appeal.
There may also have been some recourse with the Methadone clinic. The clinics are subject to DPH regulations governing the terms of involuntary terminations from treatment.
My office, the Mass. Law Reform Institute, does not take direct client calls but we are happy to consult with outreach workers about problem cases.
Vicky (vpulos@mlri.org)
Post new comment