Outreach workers at this month’s HAN meeting in Amherst reported happily that it’s getting easier to communicate with the MassHealth Enrollment Center (MEC) and Central Processing Unit (CPU). The MEC has been answering phone calls right away, without the long waits that outreach workers had been experiencing. The CPU has also become more accessible, even calling outreach workers to follow up on applications. Sighs of relief and appreciation were in the air.
Delays in the Medical Security Program (MSP), on the other hand, only appear to be getting worse. It’s taking between 8 and 12 weeks for MSP to process applications. HAN members are flooded with MSP applicants, many referred from career centers with the idea that outreach workers can get applications through faster. But they’re having trouble guiding their own clients through the system—it is virtually impossible to get into the phone queue in order to wait to talk to a representative. And the line often disconnects after the system prompt to leave a voice message.
People who receive extensions to their unemployment benefits are falling into a particular coverage gap. When their original unemployment claim ends, they lose MSP coverage and become eligible for Commonwealth Care as of the first of the following month. However, once they get the extension of unemployment benefits, they lose their CommCare eligibility—and then they must wait for MSP all over again. (Please note: people in this circumstance may contact MSP to re-open their case, rather than submit a new application, so long as it has been less than 90 days since their MSP coverage ended.)
Clients on Prescription Advantage are receiving redetermination notices that are going out in batches—they should make sure to return them to avoid losing benefits. To get additional news, you can now sign up to receive the Serving Health Information Needs of Elders (SHINE) "Flash" newsletter by email. Send your email address to SHINEflash@fchcc.org.
Following a meeting with disability rights advocates, MassHealth has instituted a two-month moratorium on cuts to the number of prior-approved Personal Care Attendant (PCA) hours a person with disabilities has per year. Three PCA consumers who brought legal cases after their PCA hours had been cut have had them reinstated.
Resources in Western Massachusetts
Tapestry Health has received a grant to target breast health and cancer screening for lesbian and transgender people. For more information, contact Suzanne Smith (see our attendance list – PDF).
Live Well Springfield is still working on a web-based resource and referral guide available to the broader Western Massachusetts community. They are trying to include as many organizations in Western Mass as possible; anyone with ideas can contact Debbie Kinney (see our attendance list - PDF).
We were joined this month by Dayanne Leal, Outreach Manager for Health Care For All. Dayanne began by discussing the progress of advocates’ meetings with the Medical Security Program (MSP). MSP has acknowledged that they are overwhelmed with applications and have added temporary workers to their staff. If you have a client with medical needs that require immediate attention, you can email the director of MSP to expedite the application (please contact Community Partners for details).
The House budget for FY2010 shows significant cuts to public programs. Neither of two amendments filed to restore funding for Outreach and Enrollment activities was included in the House budget; we will be advocating to keep it in the Senate budget. (Update: the Senate Ways and Means Committee budget was released May 13. Health Care For All has an analysis of it on their blog.)
Health Care For All will hold its Annual Health Care Policy and Organizing Conference with a focus on "A Closer Look at Health Disparities" on June 19 in Boston. Registration is free and can be done on HCFA’s website. Dayanne also mentioned that Health Care For All is seeking out new places to give trainings explaining Health Care Reform—schools, libraries, community-based organizations. If you get referrals from organizations that you wish knew more about what you do, please put them in touch with Dayanne (see our attendance list – PDF).
We were joined this month by Michael Norton and Niki Conte from the Commonwealth Connector Authority, who talked extensively with HAN members about problems and solutions within Commonwealth Care. Michael is the Manager of Medicaid MCO Contracts, and Niki is the Director of Outreach for Commonwealth Care.
Network concerns and the new plan in town
Michael engaged HAN participants in a discussion about Commonwealth Care Managed Care Organizations (MCOs). This year, Commonwealth Care will include a fifth MCO: CeltiCare. The parent company is Centene. Though CeltiCare’s original bid did not include Western Mass., it did include the Central region. HAN members explained what they are seeing in terms of the adequacy of MCOs’ provider networks in the Western and Central regions.
HAN members expressed some concern that existing network issues could become worse with the addition of a new plan if it is low-cost, since HAN members have observed that the current lowest-cost Commonwealth Care plans tend to have less of a provider network. For example, three Commonwealth Care plans are offered in the Hilltowns. Though the local community health center accepts all three, the hospital that processes their blood work—Cooley Dickinson—only accepts BMC HealthNet. This is also the most expensive plan for anyone above 200% FPL in the Western region. Clients who have a less expensive plan must go to a different hospital that may be further away, and in some cases, the blood work may not get done.
In rural areas, members may have to drive more than 30 minutes to reach a provider who accepts their plan. There is little to no public transportation and not all clients have cars. In order to gain better access, members may have to buy into a plan that will cost significantly more.
Michael provided some context for the network problems outreach workers are seeing. Commonwealth Care is a public-private partnership. The Connector does not have the authority to require providers to contract with particular health plans. The Connector does put network adequacy requirements on the health plans. But if the Connector were to make these requirements too explicit (for example, if it were to require that health plans must contract with certain providers) it could compromise the plans' ability to negotiate rates with providers. Similarly, the Connector cannot require health plans to contract with the Connector particularly if the health plans objected to more explicit, provider-specific contracting requirements. This is why the Connector has not required that health plans in the Western region contract with Cooley Dickinson Hospital for blood work, for example.
Instead, the Connector creates standards that Commonwealth Care plans must meet in order to be approved for a particular region. The Connector then allows each plan the freedom to come up with its own network and make deals with providers within the perimeters set by the requirements of their contract with the Connector. For example, the Connector is evaluating whether CeltiCare will offer adequate family planning services (a concern that arose due to the parent company’s alliance with Caritas Christi, a system affiliated with Catholic teachings). The Connector has not, as yet, made specific requirements, as the number of family planning clinics per area.
Michael pointed out that outreach workers may also call the health plans about network adequacy concerns. Health plans are required to report complaints from members, and the steps they take to resolve them, to the Connector. It would help to have specific names and individual situations to resolve when calling the plans. Michael also pointed out that Boston, like the Western and Central regions, also faces challenges with network adequacy.
As one solution, outreach workers sometimes advise members who have difficulty accessing services through a less expensive plan to submit a plan change form, however outreach workers have been advised by customer service representatives that if the change request is made outside of the annual open enrollment period, it will most likely be denied. Members of the group also proposed systemic solutions for consideration, such as incorporating network adequacy into Minimum Creditable Coverage regulations.
Open enrollment, member outreach, and changing plans
Between May 25 and June 25, Commonwealth Care will have an open enrollment period during which members may change their plan (i.e. MCO) for any reason. This year, members will receive a large, fold-out notice about this period that will be a clear and obvious communication. EOHHS network grantees should already have received a sample of the open enrollment packet that members will receive. Niki Conte also passed out copies of the Commonwealth Care Program Guide (PDF). This can also be found on www.MAhealthconnector.org within the Commonwealth Care section of the site.
HAN members also discussed client communications around premium increases. When HAN members' clients change income categories and move into a new plan type, the clients come to outreach workers and express concern over what they feel are significant increases in monthly premiums. In the Central region for example, when Network Health members moved from Plan Type II (150-200% FPL) to Plan Type III (200-250% FPL), their premiums went from $39 a month to $180.42 a month.
HAN members expressed their concern that the letter their clients receive when they move up to a new plan type suggests that they call the Connector for more information—but it does not make plain that the member will receive a $140 increase on their next monthly bill (following the above example) unless they change plans immediately.
One HAN member suggested that even if the letter could not be pre-populated with each member’s plan information, it would be helpful for members to be told what the premium range for each category is—and to be informed that they may see an increase of more than $100 unless they call to change plans.
Some late changes to our guest portion
Please note some requested changes made to the the last section of the notes.
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