The plan to continue coverage for Aliens With Special Status

Yesterday, Governor Patrick announced that CeltiCare Health Plan of Massachusetts has been selected to offer coverage to 31,000 people identified as "Aliens With Special Status" who today lost their Commonwealth Care coverage.

According to the Governor’s press release, CeltiCare will begin covering people deemed AWSS in their current coverage area, much of Boston and Southern Massachusetts, on October 1st. Celticare will expand its network (PDF) to include the entire state by December 1, 2009. Though the new CeltiCare program is not a Commonwealth Care plan, it will be administered by the Connector.

The immigrants who were just disenrolled from Commonwealth Care will be automatically enrolled in the new plan as it becomes available in their region. In the meantime, they are eligible for services from either the Health Safety Net or MassHealth Limited, depending on their eligibility category.

The new CeltiCare program will offer:

• Primary care visits, with no copayment
• Specialty visits, with a $25 copayment
• Generic prescription drugs, with no copayment
• Non-generic prescription drugs, with a $50 copayment for a 30-day supply
• Outpatient hospital care
• Inpatient hospital care, with a $250 copayment
• A $1,000 annual out-of-pocket maximum, though this does not apply to pharmacy copayments

We expect a detailed benefit list soon. Since the $40 million allocated by the legislature for this program is less than a third of the estimated cost of Commonwealth Care coverage for this group of people, there are also challenges, such as:

• The possibility of gaps in coverage while people wait to be enrolled in Celticare.
• Dental, vision, hospice and skilled nursing care are not covered.
• People who rely on non-generic medications face a significant co-pay increase: $50 for a 30-day supply with no cap on pharmacy spending.

Only Commonwealth Care members who lost coverage under the new rules will be allowed to join Celticare. Going forward, adults deemed AWSS will receive either MassHealth Limited and/or the Health Safety Net.

Some other resources that may help:

• Help accessing prescription drugs: MassMedline and the HIV Drug Assistance Program
• Locations that provide Health Safety Net services: a searchable database of Community Health Centers and listings of Health Centers and Hospitals
• A helpful Frequently Asked Questions document (PDF) from MassHealth and the Connector
• An update on Health Care For All’s blog and a summary from the Massachusetts Law Reform Institute