Several outreach workers have contacted me since the state released the RFR for "MassHealth, Commonwealth Care and Commonwealth Choice Enrollment Outreach Grants" at the end of August. They are trying to understand how the inclusion of Commonwealth Choice in the scope of work will change things.
To my knowledge, the process is the same: outreach workers can provide enrollment assistance into MassHealth and Commonwealth Care. Same as always. And for Commonwealth Choice, outreach programs can continue to do the outreach, education, and intake screening that they currently do. They must still make a referral to the Connector or a local insurance broker - who gets a commission - in order for their client to enroll in Commonwealth Choice. Outreach workers still can't directly enroll people into Commonwealth Choice.
Community outreach programs are essential as "on the ground" marketers for Commonwealth Choice - and the entirety of health care reform. Getting information out, helping people understand their options, screening them for eligibility and getting people to the right program - this has always been the expertise of outreach workers. This will continue to be true for Commonwealth Choice. Until these outreach programs are fully recognized by the Connector for the valuable and time-consuming work they do - equivalent to an insurance broker - they will be unable to enroll people directly or be compensated for their efforts.
True Michael, and well worth
True Michael, and well worth pointing out to those in a position to make such decisions regarding CChoice. Blatant ignorance of existing Outreach members capable of generating enrollments is understandable, yet jeopardizing the potential success of CChoice by "privatizing" and likely spending a lot and getting very little through the use of traditional advertising, seems to go against even what they would hope to achieve. Where is the logic?
I continue to ask the
I continue to ask the question... "Is there a list of insurance brokers who have been trained in Commonwealth Choice that we can feel comfortable referring people to?"
A broker list would be
A broker list would be great, but this morning I have been trying to straighten something out for a client who should be eligible for CC and was determined "overincome" for Mass Health and put on UCP. This client and her husband have an income under 39,600, both are retired, she is under age 65, and she is on COBRA which she cannot affford to pay and has breast cancer. MassHealth tells me to call CC and CC tells me to call MassHealth to fix this. The client actually tried to fix it herself last Friday and called MassHealth who told her to call CC, and CC told her to go to the local hospital for a "screening"(although the paperwork we submitted clearly states where the application came from). She was on the phone for 2 hours back and forth like I am today. She came back for help from us. Is it any wonder people give up?
Yes, MassHealth workers and CC workers are overwhelmed, but, someone is missing the eligibility criteria, when in fact all of the documentation was sent in and is visible to all MassHealth and CC workers.
What is going to happen when CHOICE is added to the mix?
Hi Michael, Our counselors
Hi Michael,
Our counselors have been using www.mahealthconnector.org to help patients compare Choice plans, and then clicking on "enroll" once a patient has decided. Outreach workers could do that as well, right? Understanding that then the insurance plan will communicate directly with the enrollee.
OK, that makes sense. There
OK, that makes sense. There is truly a LOT of work involved in helping someone decide on a Comm Choice plan, and outreach workers in the community, as well as counselors at hospitals and health centers, are being expected to do that with existing resources!
Kim, The process you suggest
Kim,
The process you suggest with patients enrolling in Choice plans is fine.
The point I was making was that there is a lot of work required prior to clicking on the enroll button that outreach/enrollment folks must undertake in order to know that a Choice Plan makes sense. This work includes the outreach and marketing, and a complete screening/intake process. Until screening is done, an informed recommendation on what health care coverage option makes sense is not possible. Unfortunately, while outreach workers can complete the process with enrollment into MassHealth and CommCare, the Connector decided to "privatize" this essential step- preventing outreach folks from having an official role in the enrollment process. They can hand someone off to the Connector or to a private insurance broker. But for all the work leading up to this 1)they should be compensated equal to a broker and 2)usually have a professional stake in making sure the referral works out for their client.
The structural barrier to helping with Choice is something I would hope is revisited- it surely is a way to help provide a new, alternative revenue source for cash-strapped outreach programs that are doing the work of brokers anyway. There are ways the Connector and the Commonwealth could allow non-profit outreach programs to be considered brokers for the CommChoice program - thus providing continuity for clients and a minimum of sustained funds for outreach programs.
EOHHS has posted answers to
EOHHS has posted answers to seven applicant questions so far about this mini-grant RFR. Community Partners has the EOHHS answers to applicant questions (up to the present) as a PDF.
As more questions are submitted and answered by EOHHS, they can be viewed on the Comm-Pass website by searching for the RFR under document number MH082907001 and clicking on the "Specifications" tab.
Many thanks to Mass Health's
Many thanks to Mass Health's Sherry Anderson and Joseph Souza for assisting me and our client previously mentioned on this blog. This client is now on Commonwealth Care.
Post new comment