The economic downturn shaped a lot of our discussion – how it affects clients, state services, and our own organizations. For example, more clients find themselves in tears during appointments – some with problems like home foreclosure that outreach workers just can’t help fix. Many HAN organizations are taking on additional responsibilities with fewer staff.
Many important resources are still in place, though, and people are pulling together to share lesser known "nook and cranny" referral resources. Here’s some good news:
We are now seeing the effects of the July 1 premium amount changes that accompanied Commonwealth Care open enrollment. In the North Quabbin region, what had been the lowest-cost plan for people between 250-300% FPL (Network Health) rose from $70 in June 2008 to $180 a month in July (PDF - see page 4, "Central" region). Some members whose premiums made this increase, and who have since been terminated for non-payment, are having to pay arrears at a much higher rate than they expected in order to regain their insurance. This is very difficult for people who now face other financial hardships as well. People who have switched to what is now the lowest-cost plan – Fallon Direct – have also had to switch providers. The nearest primary care offices are 30-45 minutes away by car and not always accessible by public transit.
We heard that some providers in the North Quabbin may soon stop taking Medicare HMO Blue. Standard procedure means that providers can’t notify patients ahead of time – but the wonderful volunteers at the Serving Health Information Needs of Elders (SHINE) program (PDF) are available to help find solutions for clients who may be affected.
HAN members are working diligently to help clients who receive Exceptions Notices from Commonwealth Care. However, they continue to experience delays of two months or longer between submitting a form and being able to get information about its status.
MassHealth members have been experiencing paperwork delays as well. Instances were reported in which pending cases were literally left on the desks of MEC employees who were out of the office, resulting in delays of several weeks. By following up, outreach workers were able to get the forms looked at by someone else. There also appears to be an issue with the prompt processing of verifications.
Some good news: MassHealth will not be disenrolling members whose new MassHealth cards are returned as undeliverable mail. Outreach workers do have a concern, however; new cards are already in the mail, but providers have been told not to use the new card ID number until January. We’re hoping this does not create gaps in service for MassHealth members who follow the mailing’s instructions to use the new card right away.
Budget cuts at hospitals can create a ripple effect. For example, people with disabilities who get Personal Care Attendant (PCA) services from MassHealth must now temporarily lay off their PCAs if they are hospitalized, relying solely on hospital staff to meet their special needs. Those with severe disabilities who bring a PCA to ensure their needs are met in understaffed hospitals may face fraud changes.
This month, we heard from Deb Wachenheim, Health Quality Manager at Health Care For All. Deb does policy and legislative work for the Health Care Quality and Cost Council, which brings together health care consumers to advocate for better quality care. If you have a client who has trouble accessing quality care, that person can become involved with the Council at any level (from simply being on the mailing list to sharing their story) by contacting the Consumer Health Quality Organizer, Kuong Ly, at (617) 350-2940 or by email at kly[at]hcfama[dot]org.
The quality problems considered by the Council aren’t limited to hospital-acquired infections and other "never supposed to happen" events: they can include health problems caused by trouble finding or staying with a doctor, or difficulty accessing specialty care. The Council can also put people in touch with support services for medically induced trauma.
We can expect the EOHHS Outreach & Enrollment grant Request for Responses to be released any day now. CP update: The RFR was released on Nov. 13. The ACT!! Coalition is working on codifying the program as an essential component of health care reform so that we no longer have to fight for its survival every year.
We discussed the status of a wide range of public health initiatives with special guest Bill O’Connell, the Western and Central Regional Manager of the Massachusetts Department of Public Health’s Bureau of Family and Community Health. In response to the 9(c) cuts that Governor Patrick announced October 15, the Massachusetts Department of Public Health (DPH) has had to cut its budget by about $28 million (5%), which will mean the loss of 50-100 staff positions.
Some of the more heartbreaking cuts involve substance abuse services, universal immunization, services for people living with HIV and AIDS, family planning, and pediatric palliative care. The clinic for sexually transmitted diseases at Brightwood in Springfield has had to shut its doors; referrals are now being taken by Brightwood urgent care and by Tapestry Health. Eligibility criteria for family health and nutrition programs are tightening up, so these programs will be serving fewer children.
In spite of the cuts, there is still a lot of help available for people in need. If someone is having trouble accessing services they need – or used to receive – you can find a contact within the DPH directory. Bill discussed helpful resources for people in Western and Central Massachusetts:
Bill also offered himself as a resource for Western or Central Massachusetts. If you are unsure who to call, he can help put you in touch with the right program. Bill can be reached in West Boylston at (508) 792-7880, ext. 2168 – or in Northampton at (413) 586-7525 ext. 1114.
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