July 18 and 24 HAN meetings: Sometimes they just keep coming

Because our Boston and Western HAN meetings were timed so closely together last month, we’re combining the notes blog. But we still kept the attendance lists separate:

• Western Health Access Network attendance and agenda (PDF), 7-18-08
• Metro Boston Health Access Network attendance and agenda (PDF), 7-24-08

There will be no HAN meetings in August.

They just keep coming...

Enrollments usually slow down during the summertime, but this year, outreach workers are seeing increasing numbers of people needing help. Outreach workers reported that more people are applying for MassHealth Premium Assistance than in previous years. There have been more clients coming in who are at higher income levels (between 200-300% of the federal poverty level).

The baby boom wave is crashing in, and outreach workers are getting many more questions about Social Security, Medicare, and early retirement. The Social Security Administration has created a new online tool to calculate retirement benefits.

Bumps in the road
Clients are still getting Exceptions Letters (PDF), which often request information that clients already submitted with their applications. Also, one office expressed a concern about encouraging clients to update their income information by phone, outside of the annual review cycle. Two clients who reported a drop in income received erroneous Exceptions Letters and lost coverage temporarily.

Outreach workers report that some disenrolled Commonwealth Care members are learning that they’re no longer covered when they go to the pharmacy; some clients say they don’t understand their disenrollment and have received no information about it.

Some clients were confused by receiving an ERV after they had participated in the Open Enrollment period. They didn’t return the ERV because they assumed the Open Enrollment process had taken care of it, and they almost lost coverage.

Health Safety Net News

Health Safety Net (HSN) Policy Manager Caroline Minkin (Boston HAN) and Analyst Rebecca Balder (Western HAN) explained some new technical amendments to the HSN regulations (PDF) that were adopted July 1, and answered outreach workers’ questions. Public hearings/comment periods on September 11 and 19 will review additional changes to the HSN that are scheduled to be adopted October 1.

Access:

• Only students taking a ¾ course load or more are required to enroll in the Qualifying Student Health Insurance Program (QSHIP) program. Students taking fewer credits and not participating in QSHIP can be eligible for the HSN.
• Patients with the Family Assistance Premium Assistance Plan are eligible for HSN Secondary; those with Direct Coverage are not eligible.

Affordability:

• Patients will now be charged for a percentage of what a hospital actually receives from the HSN, rather than a percentage of the "sticker price." This should help patients.
• Medical co-pays are suspended indefinitely; any provider that has collected these co-pays from patients should make reasonable efforts to refund them. (Pharmacy co-pays are still in effect.)
• The cap on pharmacy co-pays will be $200 dollars, and will apply to all income levels on a calendar year basis.
• Hospital-licensed health centers can now charge patients on a sliding scale basis before they meet their HSN deductible, like community health centers can.
• If a patient comes in just for pharmacy services, they don’t have to meet the deductible before they get coverage for those services.
• Community health centers can now bill the HSN for dentures provided on site but manufactured or repaired off site.
• Community health centers now have the option of having a one-time supply of medication covered by the HSN for a patient who can’t be seen by a provider at that location within a clinically appropriate period of time.
• Co-pays will not count toward HSN-Partial deductibles.

Medical hardship

• Applications can now be submitted only two times a year.
• Patients reporting income below 400% FPL on a medical hardship application also have to fill out an MBR to see if they are eligible for other programs.

Clarifications

• Though REVS does not show the 10 days of retroactive coverage for Commonwealth Care and some MassHealth patients, the HSN billing system does. Providers should know that the HSN is all set to accept bills for those dates, even if this data is not reflected in REVS, and that they can call the HSN for clarification of the dates.
• It has been clarified that HSN patients can receive services that are not considered medically necessary or are out of network – and are not covered by the HSN – if they arrange with their provider to pay for them privately.

We also discussed important things to remember regarding the HSN - which shed some new light on existing policies.

Policy updates from Health Care For All

The 2009 budget

• Outreach and enrollment minigrants have been level-funded at $3.5 million. This money will be released through the usual Request for Responses (RFR) process. Everyone hopes the RFR will come out before the end of August, allowing organizations to retain trained workers instead of having to laying them off because the gap in funding is too great.
• An Office of Health Equity has been created that will be responsible for tracking and monitoring work to eliminate health disparities.
• MACHW reports that funding for community health workers at Community Health Centers was reduced by $308,000, resulting in the loss of eight to ten positions statewide.

Supplemental budget
Governor Patrick's end-of-year supplemental budget recommends increasing funding for health care reform through greater "shared responsibility." It would require greater contributions from employers, insurance plans, the Health Safety Net trust fund and the Medical Security Program trust fund.

• The word "OR" in the fair share assessment formula will be changed to "AND": in order for an employer to be considered covering a "fair share," 25% of workers must take up the offered insurance, AND that insurance must pay for 33% of the premium. This could bring in about $33 million.
• The Division of Health Care Finance and Policy would do a $33 million one-time assessment of insurance plans’ "excess funds."
• Additional funding would come from a onetime increase in the Health Safety Net trust fund assessment paid by hospitals and health centers, and from the Medical Security Program trust fund, where there appears to be a surplus.