A few days after the new Health Safety Net (HSN) regulations were approved, I got an e-mail from an outreach worker in a Western Massachusetts community health center that made me stop and think. She had read on our web site that the HSN will now cover the same services MassHealth Standard covers. She was very excited. Because their health center doesn't have a pharmacy, she envisioned her patients finally being able to get prescriptions filled at a local drug store rather than having to find a way to get out to the UMASS Medical Center in Worcester very few of their local physicians offer specialty services to HSN patients, she has been sending people all the way to the UMass Medical Center in Worcester, and she hoped the changes meant that the health center's patients would now be able to get specialty services locally.
For a minute I got excited too. But then I was reminded that the Health Safety Net IS NOT health insurance. HSN is a pot of money that pays for some costs for some services that hospitals and health centers provide to some people who have no way to pay their bill.
Previously the standard of 'medical necessity' was applied to UCP services. If a provider in a covered setting said a patient needed a service, then it was 'medically necessary,' and if the hospital or health center was licensed to provide that service, the pool would pay for it. Now, in order for a hospital or health center to get reimbursed, a service must be one that's medically necessary, on the list of services covered by MassHealth Standard, and a service that the billing hospital or community health center is licensed to provide.
In other words, my friend's patients who qualify for the HSN will still have to find a way to travel the 100 miles to UMASS Worcester.
We're lucky to have the Health Safety Net for the uninsured and underinsured. As far as I know, Massachusetts is the only state in the union that has created a fund to reimburse providers for uncompensated care they give. Many have fought hard to keep it available to cover the costs of those who won't benefit from health care reform. However, although these changes may make the safety net line up with other health care reform programs, they do not fill in the holes. A person can still fall through.
We've just updated
We've just updated our blog post. We've learned that our prescription drug example was misleading. To clarify: while UMASS Medical Center does provide specialty services to HSN patients, the Prescription Center at the University will only fill HSN prescriptions written by providers within the hospital. I called a few community health centers and confirmed that their pharmacies provide HSN prescriptions only to their own patients. So what do people do when they are eligible for the HSN, have a prescription that needs to be filled, but no provider to do it? Keisha gave us some examples; are there any more?
I got just as excited when I
I got just as excited when I read the ad which is a little deceiving. Because I also work at a health center in Fall River and our local Hospitols do not have pharmacies. But we started a access to medication voucher program which is funded by local $ donations. I outreached to a local pharmacy which for a small fee will accepted our patients. We give them a one time voucher with a prescription to go to pharmacy and pick up their meds and pharmacy bills the health access program and we pay pharmacy with funds donated from our local community.
I've sent out a link to this
I've sent out a link to this comment to several people. I'm not sure where Sue went in Fitchburg or Lowell, but most health centers, if they do have a pharmacy, need a person to "belong" to the health center to use the benefit. Anybody know how long it takes or what you have to do to become a member? Can you "join" and then use existing prescriptions, or does someone have to be seen and prescribed by health center provider?
Any thoughts would be great. If I learn anything, I'll let you know.
Meg
My son had a stroke at 35.
My son had a stroke at 35. He was on Commonwealth Care. By their error he was dropped the first of Oct. He is on UCP and we cannot find a way to get his prescriptions filled. He has been to 2 clinics, seen drs. and then found out they had no pharmacy or voucher program. I have been calling a number that is so overloaded with calls you have to leave a message. This is day 3. No response. It could be life threatening without his prescriptions. We cannot find where to turn as we are in Groton MA. He has been sent to Lowell and to Fitchburg but both places said they couldn't help him. Any ideas? He's pretty desperate. His medication is in excess of 300.00 and we just don't have the money to pay for him.
Thanks
Sue
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