This month, people were talking about budget cuts, staff reductions, and unemployment. Many outreach and enrollment sites are facing cuts though their caseloads are increasing. As unemployment rises, calls for assistance with the Medical Security Program (MSP) are making up half the volume at some outreach sites. Some of these clients have already been unemployed for a long time and are losing their MSP coverage, and don’t know what to do. Outreach workers are being called upon by businesses to go out to workplaces and explain health benefits under unemployment, and one site said they haven’t had this kind of call volume since health care reform first started.
Outreach workers report concerns that people with disabilities are not accessing appropriate care because they are getting on Commonwealth Care in place of other subsidized coverage. CommonHealth used to be the only option, and the spend-down, while challenging, was consistent. Now, people with medical needs that go beyond what Commonwealth Care is set up to cover are facing gaps. There is also some concern about whether, given the volume of patients, doctors’ offices are completing disability paperwork adequately.
Outreach workers are concerned about missing eligibility review forms. In some cases, neither the site nor the client got an ERV. In other cases the site did, but the client did not. Outreach workers have confirmed addresses with MassHealth, but still have clients who don’t receive an ERV. More than three separate sites noted this problem. One HAN member said, "I fully accept that I have plenty of clients out there who don’t bother reading their mail. But one or two people have come to me who I know darn well are completely anal about their paperwork."
Finally, some outreach workers are seeing clients who’ve signed up for a MEGA Life health insurance plan, hoping to meet the individual mandate. While MEGA Life may have one plan that meets Minimal Creditable Coverage (MCC) standards, the majority of its plans offer far less than is required in Massachusetts. Insurance salespeople are not required to inform potential members that their plans don’t meet MCC standards unless they are asked directly.
Kate Bicego, who manages Health Care For All’s Helpline, explained advocacy efforts in context. A large deficit remains in the state budget. While organizations are still responding to the first round of 9C cuts, another round of 9c cuts (anticipated at the time of our meeting) has since come out. State officials say they are committed to preserving services and will not cap caseloads or reduce services under MassHealth. On the bright side, it looks like the federal government will soon increase the amount of reimbursement it gives for the state's Medicaid spending.
ACT!! Legislation
The ACT!! Coalition has put forth a number of bills for this legislative session. "An Act Strengthening Health Reform" (PDF) would align Commonwealth Care applications and appeals processes with MassHealth, to improve continuity of coverage and simplify the process. This change would mean Commonwealth Care coverage would begin on the date of application rather than the date a payment is received. This Act would also codify the MassHealth Outreach Grant program, so we are not fighting for the both the concept and the funding each year. Another bill, "An Act Relative to Health Care Affordability," (PDF) would compel the Connector to take the real costs of health coverage – such as co-pays and deductibles – into account when creating the annual Affordability Schedule.
MassHealth Updates
Attorney Nic Mazanec set the context for our discussion of the Medical Security Program by distributing a FAQ document about unemployment benefits (PDF) prepared by Monica Halas of Greater Boston Legal Services. He introduced his former colleague Wendy Kane, who will be handling MSP cases at Western Massachusetts Legal Services. The Medical Security Program (MSP) is the only program in the nation offering health care coverage for people receiving unemployment benefits. The new Obama administration is looking to it as a possible model.
For advice about handling MSP cases, see these FAQ's from HAN members about the Medical Security Program (PDF). (updated May 2009)
What are the eligibility requirements?
What are the income guidelines?
The Massachusetts Division of Unemployment Assistance adds up a family’s actual income in the 6 months before the MSP application and its projected income for the next 6 months. This total "annualized income" can’t be more than 400% of the Federal Poverty Guidelines. Income earned by dependent children is not counted. (NOTE: The Massachusetts Law Reform Institute has just released a chart with 2009 income standards (PDF) for many health-related benefit programs, including MSP. Look for the "400%" column on page 2.)
The MSP offers two plans:
For further details, see the MSP brochure (PDF), MSP application (PDF), and the Massachusetts Division of Unemployment Assistance website.
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