Why are people losing coverage?

I had a similar problem when I applied EAEDC and the two parts that are most serious in my mind are: 1) i was disenrolled from CC _without notice_; and, 2) MassHealth coverage is substantially different from CC. I've been referred to legal services groups but have nothing to show for it yet.

Dr. Tom Dean recently wrote in his column in Rural Roads that as long as 75% of the population (who can afford it) are happy with their coverage and afraid that it will be reduced, we can never get true health care reform. The Clinton plan is 14 years old now. It could no more move forward today than it could then. People are afraid of major system change and will continue to block it. There are also powerful vested interests in maintaining our current "broken system". Commonwealth Care will eventually fail also as we refuse to look at the real issue, rising health care costs. No entity, public or private can sustain rate increases of 6-15% a year.

Jackie,
Your post obviously hit a nerve! I would urge you to refer your client to your local legal services offices or to Health Law Advocates. No one who was determined eligible and enrolled in a plan should be disenrolled without advance written notice from MassHealth or the Connector and an opportunity to appeal. Plans can ask the Connector to disenroll someone but, as I read the regulations, the Plans cannot disenroll someone on their own. If this happened to your client he or she needs a legal advocate.

The EAEDC issue is trickier. Applicants for EAEDC are immediately eligible for an EAEDC-medical benefit. The regulations on this are at 130 CMR 450.106. To access this benefit DTA (on request) will issue a temporary paper MassHealth card. This paper card does not appear in REVS but DTA will often explain it to providers & there is a special protocol for pharmacists to bill. This EAEDC medical coverage continues until the person is enrolled into MassHealth Basic.

Vicky Pulos, Mass. Law Reform Inst.

Now that CommCare is added to the list of available health coverage options for low and moderate income residents of Massachusetts, it is becoming clear, esp. with all the comments above, that implementation in FY08 requires further integration among all these programs. Perhaps the newly created (assuming no Gov. veto)Health Care Reform Unit that was wisely created by the legislature can help with this. The goal should be to figure out how to knit the myriad of health coverage options together so that people in need don't find themselves without coverage and care. Beware the poor person who does not have an outreach worker guide to him/her through these many systems.

Massachusetts may have moved closer to covering more people with some form of coverage but the programs remain fractured and ill-coordinated. While some programs are closely linked operationally, all have different rules, different customer service and different "agency" homes. For ex, CommCare is operated by a separate authority - the Connector, MassHealth and CMSP by EOHHS, Prescription Advantage by Elder Affairs, Medical Security Plan by Division of Unemployment Assistance, Free Care by Division of Health Care Finance and Policy, Men's & Women's Health and Centercare by DPH. Knowing where to go for what is the expertise of you'all providing enrollment assistane but clearly NOW is the time to start making our patchwork quilt a seamless blanket for quality coverage. Otherwise we will continue to see people losing needed coverage at critical times; exactly what increases costs, skepticism and frustration.

I think we all agree that enrollment into Commonwealth Care is a process that is so extremely complicated. Since the members in this population are usually bouncing back and forth between this and other programs, it must be streamlined so that people are not left with gaps in coverage. I have a hard time understanding why this has not been the case since all eligibility is being determined by MA-21.

PLEEEZ Keisha and others!!! Listen to what you're saying. The "system" as it is now is so very very broken that only when we thoroughly reject this mandate law and DEMAND that it is replaced with something that actually works.

The "little glitches and gray area" cracks are there intentionally, sanctioned by the healthcare industrial complex. These cracks exist purely because we (we The People) continue to accept healthcare being treated as a commodity instead of insisting that it be treated as a public good and human service.

PLEASE help build this vital social movement. Thank you.

Re: "Keisha De Jesus, SSTAR Health Center Says:

I happen to have faced a similar situation. I had a patient who was on CommCare and was terminated and put on UCP because he went and applied for Transitional assistance. When he called MH, they told him that his case now belongs to the...Its so hard to get them insured and so easy for them to lose insurance because of these little glitches or gray areas."

I happen to have faced a similar situation. I had a patient who was on CommCare and was terminated and put on UCP because he went and applied for Transitional assistance. Whe he called MH, they told him that his case now belongs to the Transitional assistance office. Then he called the Transitional assistance office and they told him he would be enrolled again in CommCare the first of the following month. In the mean time he is in need of heart meds, anxiety meds, and a few others and no insurance and limited coverage. So i spoke with his primary physician and got him some samples of two meds unfortunately we could not provide him with the most important one his heart med. It is sad to see how they fall between the cracks even once insurance is adquired. Its so hard to get them insured and so easy for them to lose insurance because of these little glitches or gray areas.

It's a shame, but it seems Commonwealth Care is to be considered to be the "insurer of last resort" rather than the savior of the uninsured, and sadly an open DTA case is not the only instance where an applicant can be denied CommCare coverage while the case is pending. If a new applicant pursues a disability status through MassHealth, they will be denied CommCare coverage while their disability case is being decided; a process that can take more than 90 days to complete. I understand the thinking that an applicant should receive the richest benefit allowable, but to deny a person in such a condition coverage in these ninety days is simply bad policymaking. Also, how will the play out when there are penalties for being uninsured. Will a disabled person go without coverage while the case is pending then face a tax penalty for those three months he was uninsured?

There is similar situation where eligible taxpayers needlessly lose coverage. When a person's insurance coverage ends they receive a "letter of creditable coverage." This letter serves as proof of insurance and allows him/her to immediately enroll into a new insurance plan with few restrictions. For some reason, this common practice is incompatible with CommCare. When a person loses MassHealth coverage and becomes eligible for CommCare he/she must then choose a health plan and mail in his/her first month's premium to CommCare's New Jersey office by the 20th of the month before the new coverage can begin. Any person that loses coverage after the 14th of the month will most likely remain without insurance for an additional 3-5 weeks. Quite a few of my clients have gone without necessary health care because of this circumstance.

In real life, this means that chemo and radiation therapies are skipped, diabetics go without insulin, and life-saving mental health appointments are postponed. There are real consequences that result from these unaddressed issues. If only health issues would hold off to the first of the month like CommCare coverage does, we wouldn't find ourselves in this situation. I understand that the legislation was thoughtfully written to head off a number of potential problems, but when will it be time to revisit the legislation to make meaningful technical corrections? I hear much ado about whether or not the program is financially solvent, but not enough about whether it's serving the actual needs of the people.

I was contacted recently by a resident with the same problems regarding the suspension of his CommCare. He had been to DTA to fill out an application for EAEDC but NEVER submitted the application because they would have forced him to access a retirement fund. Despite withdrawing the application he was still suspended from CommCare coverage in the middle of the month while undergoing treatment for a chronic illness and on a wait list for necessary surgery.
When we inquired at CommCare about what could be done we were told he has to wait until the first of the month to be re-instated (which he was). But what is he supposed to do for 2 weeks prior to re-instatement? Who will pay for his VNA, his medications, his surgery when he gets called??!! He payed his premium!
The state Rep's office is aware of the problem and is working to try to prevent it from happening in the future.

The DTA does give a form of temporary MassHealth to some individuals, however it will only cover ED bills and the primary care according to his DTA worker. For whatever reason he was not going to be given this and so he was left with what we could get him covered through the Physician Network and discounted medication programs.