At the time of our June HAN meeting, we were unsure whether we would have the funding to continue beyond the summer—but we can now say for certain that we will see you in September! And it will be an exciting time. We’re looking for ways for outreach and enrollment workers to be more involved in national policy discussions, because you’re the ones who know best how health reform would work on the ground.
But there’s no denying times are tough. Some of the agencies represented at HAN are losing staff. The Women’s Health Network in Franklin County has been reduced to one staff member, and their Men’s Health Partnership site has been eliminated, all due to budget cuts. Outreach workers at HAN are continuing to assist people who are laid off to apply for health coverage—even elders who are laid off and are also Medicare-eligible.
NewMMIS gets its start
HAN members shared some suggestions for navigating the new system—such as printing all billing records for future reference in case a low-income patient is mistakenly billed, and printing out application dates from My Account Page to prove retroactive Health Safety Net coverage. One HAN member also suggested a conference call between MassHealth technology staff and outreach workers to problem-solve NewMMIS issues.
A few of those issues came up, such as difficulty finding accurate member information when searching using name and date of birth, and confusion around new eligibility terminology. Evidently, some Commonwealth Care members became confused about when their coverage started because NewMMIS didn’t provide enrollment dates specific to each case. Though HAN members found many problems could be resolved by accessing My Account Page, they do not have MAP PSIs for everybody they see.
Since our June 5 meeting, MassHealth has released Frequently Asked Questions and a chart of eligibility codes and messages that may clarify some issues.
State budget issues have been rapidly evolving. We are still waiting to see what happens with legal immigrants who may face loss of their Commonwealth Care coverage. The Massachusetts Budget and Policy Center has an analysis of the budget the Governor signed into law; Health Care For All’s blog summarizes the Governor’s vetoes; and, at the time of this writing, the legislature is still considering overrides.
Legislative aides present at the HAN meeting underlined that the state had to lower expenses to match the reality of our revenue. This is why the legislature chose to fund outreach and enrollment through an Outside Section.
Our special guest was Toby Guevin, State Policy Director for the Massachusetts Immigrant and Refugee Advocacy (MIRA) Coalition. Toby emphasized the value of forming a relationship with HAN members. MIRA is active in state and national policy discussions and engages in advocacy, training, technical assistance, and leadership development; and in doing that work, it is important to have a connection with people who are engaged in direct service work for immigrants.
Toby shared a list of resources on immigrants and health care (PDF) and a copy of his presentation on immigrant eligibility (PDF) (please note: coverage for special status immigrants is changing). He explained that immigrants’ eligibility for health benefits depends on what their immigration status is. There are three main categories:
"Federally qualified" immigrants:
"Aliens With Special Status:"
"Non-qualified" immigrants:
The National Immigration Law Center has published descriptions and samples of typical documents (PDF) used by immigrants in various categories.
Gaps in coverage for immigrants
Immigrant eligibility is often for emergency services only. The largest gaps in care occur for non-qualified immigrants (there are about 250,000 people who are undocumented in Massachusetts). Non-qualified adults with citizen children are often unaware that their children are eligible for benefits.
Approximately 30,000 Commonwealth Care members designated as "Aliens With Special Status" (AWSS) may face termination of their health coverage as a result of the FY2010 state budget. If the legislature does not adopt the Governor’s proposal to provide alternate coverage, these former CommCare members may fall back to the "non-qualified" category.
Elderly and disabled AWSS will still get MassHealth Essential, but it does not provide the long-term, rehabilitative, or home care they often need. It does cover hospital stays, however, which can then become the default source of care. The MIRA Coalition has filed legislation as part of the ACT!! Coalition’s core bill (PDF) that would give the Office of Medicaid the authority to decide when long-term care and rehabilitative services are medically necessary for MassHealth Essential members. This could save the state money on expensive hospital care.
Barriers to care
Language remains a major barrier to getting benefits. Many people do not know that if no interpreter is available at MassHealth, you have the right to request that they use the Quest language line.
Another barrier is the common misconception that receiving health care could hurt someone’s chances of getting a green card or becoming a U.S. citizen by making them a "public charge" (PDF). Refugees and immigrants may also be wary of dealing with government programs because of prior bad experiences with authorities both here and in their countries of origin.
Recently, MassHealth has been requesting Social Security Numbers for battered immigrants; this should not be the case, so the MIRA Coalition has been working together with the Massachusetts Law Reform Institute (MLRI) to clarify this in the regulations.
Looking forward to better policy
New federal rules will allow MassHealth to expand coverage for children and pregnant women who are legal permanent residents or parolees, but have not yet resided here for 5 years. It looks like 6,500 kids will be able to move from Family Assistance to MassHealth Standard, and 35 women will be able to move from Healthy Start to MassHealth Standard. Toby anticipates that MassHealth will implement this change in summer of 2009.
Together with MLRI and the National Immigration Law Center, MIRA recently sent a brief to Senators Baucus and Kennedy about strengths, weaknesses, and lessons learned from Massachusetts Health Care Reform to consider as they propose federal changes. MIRA is also active in federal legislation for immigration reform.
Q: How do we know whether an immigrant client is "federally qualified," an "Alien With Special Status," or "non-qualified?" How can we tell the difference?
A: There are different forms of identification. Their card/documentation (PDF) should show what their status is and how long they have had that status. One confusing thing is that on the pathway to citizenship, some people may change status—for example, move from being an asylee to a green card holder. In cases such as this—where an immigrant moves from having a qualified status to having a green card—they can be considered "federally qualified" once five continuous years have passed in these statuses combined. This is why it’s important to ask people not only what their current status is, but what their previous status was and how long they have had each status.
Q: Do you find that people know their status?
A: Some people don’t, but a lot of people do; they should keep their documentation close to them.
Q: Can individuals who are here on visas qualify for health care?
A: People here on visas are non-immigrants and are not eligible.
Q: What about people with visas getting the Health Safety Net? For example, we sometimes see camp counselors who come from Europe.
Response from group: You are still supposed to be a Massachusetts resident in order to access the Health Safety Net.
Q: It seems as if not all MassHealth workers know what immigrants may be eligible for—or they may put them on a program but then terminate their coverage later and ask for birth certificates or Social Security numbers. Do you know how MassHealth is addressing the need to train their workers?
A: There are always going to be some differences between different workers’ level of knowledge, and the MIRA Coalition supports MassHealth in enhancing their training. You can contact the MIRA Coalition if you are having problems with this.
Q: I have a client who has lived in the U.S. for less than 5 years and has a green card. MassHealth only found him eligible for MassHealth Limited coverage—is this right?
A: It depends on his status. People who have green cards should generally be eligible for Commonwealth Care until and unless the FY 2010 cut takes place.
Q: Is the cut in Commonwealth Care only for people who are "Aliens With Special Status?"
A: Yes. People who are over the five-year bar (i.e., have been in the US for more than five years and are "federally qualified") will still have access to Commonwealth Care. The 28-30,000 people who may be cut will only have access to the Health Safety Net and MassHealth Limited. The Massachusetts Hospital Association is estimating an $87 million shortfall in the Health Safety Net—so community health centers and safety net hospitals would be absorbing some of the costs that Commonwealth Care will save.
Q: During interviews with immigration officials, officers sometimes ask immigrants about the health benefits they receive, and tell them that MassHealth is a "public charge."
A: That is wrong, and when officers ask questions like that, it can be where the misconceptions start. We have a good working relationship with Citizen and Immigration Services and the Department of Homeland Security. If you tell us, we will talk to them about what is going on.
Q: MassHealth Essential was originally intended for the long-term unemployed, but is now also being used to provide benefits to elderly and disabled immigrants. What will happen to the long-term unemployed if the program is capped? Is there a more appropriate place for elderly and disabled immigrants to access care, such as MassHealth Basic?
A: I agree that there are more appropriate benefit categories for elderly and disabled immigrants; however, prior to the passage of Health Care Reform, they did not even have access to MassHealth Essential. About 4,500 elderly and disabled immigrants are on there now and this has been a bump up for them from what they were getting before.
Q: I have had a problem with my clients on MassHealth Essential not being permitted to pick a primary care physician.
Response from group: We have also seen this, because some people are in the system as having both MassHealth Essential and MassHealth Limited. MassHealth does not allow them to pick a doctor if they have Limited (i.e. emergency care only).
Q: Where can people on the Health Safety Net go to get prescriptions filled?
A: It can be difficult; people often travel far to wait in long lines. Only safety net hospitals and certain community health centers fill these prescriptions. In Western Massachusetts, the Holyoke Health Center is a good resource.
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