MassHealth and Commonwealth Care enrollments have slowed, and outreach workers are concentrating on "churn" problems, eligibility renewals and how to help clients whose CommCare premiums will go up on July 1.
Commonwealth Care - Open Enrollment hurdles for plan members
The Open Enrollment period for Commonwealth Care started May 1, the day before our meeting, and will extend until June 13. Premiums and some co-pays are going up as of July 1, and a plan type is being eliminated – so the decision whether or not to change plans is a serious one for many.
Outreach workers say it’s complicated: in many areas, if you want to change to a different plan for financial reasons, you many not be able to keep your same providers because they don't have a contract with your new plan. And out here in Western Massachusetts, you may also have to travel a long way to get to a new provider. Outreach workers also say that their clients have had trouble understanding the information they’re receiving in the mail explaining all the changes. (We wonder what will happen to all the people who don’t have an outreach worker to help figure out what their best choice will be.)
The cost of switching CommCare plans
People want to remain with their doctors, but their doctor may not be a part of the least expensive plan's network; that plan may have a sparse network, or no specialists, so people will have to keep their present insurance if they want continuity of care.
The cost of keeping their doctor by staying in their current – and now "more expensive" – plan is the source of much confusion, particularly because people between 100.1-150% FPL (Plan Type IIA) who used to pay nothing will now have to pay something. The amount is based on a complicated formula. We researched this question and here’s what we know: this amount has ALREADY BEEN CALCULATED and appears in the premium chart (PDF). If you want to know how much someone will have to pay, look on the chart. Period. Do not do any math... just follow the chart.
Outreach workers framed some other important questions raised by the gaps in provider networks: What are the factors that plans consider when they think about expanding their geographical coverage? And what are the factors providers consider when deciding which plans' networks to sign on with?
Ongoing concerns...
Exceptions letters asking for information about employer-sponsored insurance are still a headache for outreach workers and their clients because they can cause gaps in coverage. In response to an outpouring of questions, Commonwealth Care has issued an exceptions letters FAQ (PDF).
In addition to the time many organizations are spending to maintain the enrollment of a larger number of people in a wider range of complicated programs, many are still doing outreach – in mobile health vans, in caravans with other community service agencies, at health screening events. Some outreach workers predict new situations will require more outreach: for example, the downturn in the economy is resulting in lay-offs in Western Massachusetts, so more people will be losing employer-sponsored insurance. And some areas will see an influx of part-time seasonal workers in the summer.
Finding providers to see people newly enrolled in coverage is still getting harder. Ed Sayer, Executive Director of the Hilltown Community Health Centers, reported that the primary care provider shortage is actually getting worse because doctors are leaving the area. They’re going to other places where they think the situation will be better.
Clarifications from Health Care For All
Jen Chow addressed some questions outreach workers had raised earlier about the Open Enrollment process:
Health Care for Some
Why does Community Partners continue to show such broad support for this so-called health care reform when so many are being harmed?
Residents could not afford the 2007 costs nevermind the increases slated for July 1, 2008. The increases in the copays discourage care, thereby saving the state (and providers) money. What good is health insurance if you can't afford to use it and/or can't find a doctor?
MA legislators et al say that for this to succeed, public support is needed. Sounds like wishful thinking to me. This law is harming far too many residents and the public is not going to support a law that is exploiting their friends and
neighbors and hurting small businesses. The success spin is just that - MA trying to save face as this mess splits at the seams.
How can you call this a success when at least half of the targeted population is being hurt either financially, medically or both? It is commonly referred to as "the Massachusetts experiment" or "an honorable, first-time experiment." Did we give our permission for MA to experiment with our lives?
Deval Patrick announced on NECN several weeks ago that the state has collected $7.9 million in fines so far. Is this something to be proud? Maybe he should receive a medal? He should hide his head in shame. That $7.9 million is blood money - money that was needed to pay last year's heating bill, transportation, gas, food, clothing, property taxes, etc.
Brian Rosman (HCFA) posted on the WBUR blog: “Stuff happens. Always does. The issue is what happens next.”
When you can't get the medication you need for your kidney transplant or you have to stop chemo or radiation - oh, well. Stuff happens. Shame on Brian Rosman.
Mr. Kingsdale says that the state's commitment has been unwavering. No, the politicians and insurance company CEOs along with other powerbrokers have been supporting this law because they are profiting from it. And they will come out of this unscathed when all is said and done while multitudes of low-to-middle income MA taxpayers will not.
The best thing that could happen at this point is that the Medicaid funding is not forthcoming. Then those of us who are being financially choked to death and stressed out trying to figure out how to survive this will finally see some light at the end of the tunnel. We can stop cutting back on income so penalties or premiums will be lower and start living productive, fulfilling lives once again.
It is ironic that a law that is supposed to provide health care is causing so much stress which is extremely unhealthy.
Billions that could have been used for real medical care for real people have been wasted on this colossal nightmare.
Insurance for all?
We just had a look at our County's data from Monitoring the Human Condition 2008 Update. This data was collected Nov and Dec 07 through Jan and Feb 08, so partly before the deadline, but
it reported that 41,600 of our approx 220,000 Cape residents DO NOT HAVE HEALTH INSURANCE!
What are others finding?
Also, when my daughter went to have a prescription filled, she was out of refills so the pharmacy called her MD and was told she was no longer a patient of their practice. With follow-up she discovered it was because she owed the $20
co-pay from her last visit and she would not be reinstated as a patient until she was reviewed by their medical review board. Given this is a medication that is not supposed to be stopped abruptly, this leaves her in a fix, and I am sure many others in the practice as well. Is this more fallout from "universal healthcare?"
To BL Hathaway, Your
To BL Hathaway,
Your daughter's problem is not due to fallout from "universal healthcare."
First of all, what is taking place in MA is NOT Universal Health Care. It is Mandated Health Insurance. It has nothing to do with care and everything to do with insurance company profits.
The MA model has many, many layers of unnecessary bureacracy and is prone to administrative errors sans cesse that, unfortunately, are causing very serious problems for low-to-middle income MA taxpayers. Thousands have been involuntarily disenrolled which not only causes medical problems regarding continuum of care including access to medications, much stress which is very bad for one's health and also forces people to pay penalties even though the errors were administrative.
Coverage is not retroactive and taxpayers have to jump through hurdles to find out what went wrong, what to do, etc. More stress.
Those who can't afford the insurance are racking up monthly penalties that they can't afford either. They already lost their 2007 state personal exemption which is money they needed to pay living expenses.
This law was sold to the legislature as an emergency and was passed without these lawmakers understanding much obout it other than what they were told. To date, most of them know next to nothing about it and ignore the viable complaints and problems experienced by constituents.
It is a we'll-figure-it-out-as-we-go-along operation - the same as flying by the seat of one's pants. It's the "Massachusetts experiment" and if people are hurt by this as the state plays with their lives, so be it. Collateral damage. What goes wrong doesn't affect the politiciians or the Connector. They will come out of this unscathed.
Commonwealth Care members can't find doctors. Why is this? MA already had a shortage of primary care docs. This law exacerbated that problem and, if you ask Jon Kingsdale, CEO of the Connector Authority, how much he is willing to pay Commonwealth Care docs, you'll know why they can't take these patients. They can't afford to hire additional staff and/or pay their overhead at the low reimbursement rates.
The Connector is disconnected to reality. Millionaires are deciding how much we can afford to pay and shoving it down our throats. They have no clue how to live on $24,000 a year. For them, a $77 policy with $20 copays is chump change. For us, it's heat, food, gas or property taxes. Same with the penalties.
True Universal Health Care a/k/a Medicare for All - everyone in, nobody out - affordable, comprehensive, quality and guaranteed health care (unlike what has been foisted upon us in MA) is what we want, no substitutes are acceptable. Health care is a human right, not a commodity to be sold on the marketplace.
Check out HR676 on U.S. Congressman John Conyers website and sign onto the resolution. This is what we will demand from our next president. We are the people. This is our country and our government (although you wouldn't know that in Massachusetts).
Good luck with your daughter's problem. I hope you found your way out of this without too much difficulty and it doesn't happen again.
Post new comment