February 2018

February 28, 2018

Starting tomorrow, MassHealth is enrolling most members into new health plan options, including Accountable Care Organizations. The change will impact up to 1.2 million MassHealth members.

What are MassHealth Accountable Care Organizations (ACOs)?

ACOs are provider-led organizations that coordinate care and are accountable for the quality and total cost of care of its members. Primary Care Providers (PCPs) work together with members and their team of network providers to coordinate care and connect members with available services and supports. MassHealth ACOs are a new kind of managed care option.

Who is eligible to enroll in an ACO?

People who are required to enroll in some kind of MassHealth managed care plan are eligible to enroll in an ACO. This only affects people who have MassHealth as their only health insurance coverage.

Who is not eligible to enroll in an ACO?

  • People who are enrolled in MassHealth and other health insurance coverage (for example Medicare or employer-sponsored health insurance).
  • People who are eligible for or enrolled in One Care, Senior Care Options (SCO), or PACE.
  • Seniors who are eligible for MassHealth based on their age.
  • People who are only eligible for or enrolled in MassHealth Limited.

Will an ACO be my only option for coverage through MassHealth?

In most areas of Massachusetts, MassHealth members required to enroll in managed care will have the following health plan options:

  • One or more ACO
  • Two Managed Care Organizations (MCOs) – Tufts Health Together and BMC HealthNet
  • Primary Care Clinician (PCC) Plan with the Massachusetts Behavioral Health Partnership

When do new plan options go into effect?

New MassHealth plan options, including ACOs, go into effect March 1, 2018. If you received a green-stripe letter, these new options apply to you. You may have already been assigned to a new ACO.

Can I keep all my current doctors?

MassHealth assigned members to plans that their primary care provider (PCP) participates in. You should check your doctors and/or your health plan to make sure your other providers, including specialists, are included in the new plan’s network. If they are not, you can work with you provider and plan to see if they can join the network, or you may consider switching plans.

What happens to prior authorizations or upcoming medical care?

Even if your current providers are not in your new plan or your new plan has not authorized your services, you will be able to keep scheduled appointments with your current providers and use previously authorized services through at least May 31st. You should work with you plan and providers to figure out your options after March 31st.

Will I be able to switch my ACO or health plan?

MassHealth members have until June 30, 2018 to switch plans. After that, MassHealth members can only switch plans for certain reasons, until March 1, 2019. People who become eligible for MassHealth after March 1, 2018 will have 90 days from the start of their MassHealth coverage to switch plans.

Where can I get more information about my enrollment options?

-Suzanne Curry

February 21, 2018

Last week, The Greater Boston Food Bank (GBFB) and Children’s HealthWatch released the first study of the health-related costs of hunger and food insecurity in Massachusetts. With one out of every 10 people in Massachusetts unable to afford enough food to lead an active, healthy life, An Avoidable $2.4 Billion Cost reveals exactly what its title says: the costs of debilitating health issues that are attributable to food insecurity are high…and avoidable.

The study breaks down the correlation between hunger and debilitating health issues that are attributable to food insecurity and presents the conditions – and their costs—in seven main categories:

  • Poor General Health: $635.4 million
  • Pulmonary Diseases: $572.6 million
  • Special Education: $520.3 million
  • Type 2 Diabetes: $251.1 million
  • Mental Health Conditions: $223.3 million
  • Obesity: $132.7 million
  • Rheumatology Diseases: $76.9 million

Hunger and food insecurity have particular and long-lasting ramifications for children—with negative effects that often persist through the lifespan. GBFB president and CEO Catherine D’Amato tells The Boston Globe: “If a child misses the right nutrition early on in their life…it can limit their potential to be an active citizen in their community. That damage is done.”

GBFB and Children’s HealthWatch encourage leaders in the health care community to join forces with policymakers at both the state and federal levels to reduce food insecurity, improve the health of food-insecure Massachusetts residents and reduce healthcare costs for individuals, families and the Commonwealth. Specific policy recommendations include:

  • Healthcare providers should screen patients routinely for food insecurity.
  • Congress should maintain the current funding levels and structure of the Supplemental Nutrition Assistance Program (SNAP).
  • Funding of the Massachusetts Emergency Food Assistance Program, which helps the state’s food banks serve the 700,000 food-insecure people in our state, should be increased to $20 million in FY19
  • Massachusetts should implement a common application for MassHealth and SNAP.
  • Massachusetts high-poverty schools should institute breakfast after the bell programs.

 As a consumer advocacy organization, Health Care For All (HCFA) knows that social determinants of health—factors such as lack of affordable housing, food insecurity, transportation barriers, limited access to well-paying jobs, and exposure to violence—contribute to poor health outcomes, drive up health care costs, and create health inequities across race and income. HCFA believes that addressing the social determinants of health (SDOH)—including hunger and food insecurity—is a critical component of our mission to create a health care system that provides comprehensive, affordable, accessible, and culturally competent care to everyone in Massachusetts—especially the most vulnerable among us.

The new MassHealth Accountable Care Organization (ACO) program provides an opportunity to begin to address some of the SDOH needs of MassHealth members. HCFA will be monitoring how these new ACOs use “flexible funds” to address social service needs, and we hope to learn more about the SDOH needs of the ACO member populations and the impacts of these interventions over time as the ACO program rolls out.

-Natalie Litton

February 8, 2018

With the end of Open Enrollment approaching, Health Care For All (HCFA) decided to host one last enrollment session in the city of Framingham on Saturday, January 20th 2018 to help those residents who still needed assistance applying for health insurance. HCFA coordinated an event alongside Rede ABR Radio Brasileira, the Joint Committee for Children’s Health Care in Everett, and the Edward M. Kennedy Community Health Center to serve the community.

A group picture featuring all of our dedicated volunteers following a successful enrollment session

Upon arriving in Framingham, the team quickly realized that many people were in need of help. While the enrollment session was not scheduled to begin until 10 AM, the line was already snaking around the outside of the building at 7 AM. Temperatures started in the 20’s and didn’t climb much during the day so we knew that something had to be done to help those standing in line in the cold. Along with cold hands and noses, many of these residents had small children with them as well. Some residents were moved to a backroom opened by ABR Radio Brasileira, our host, where kids had activities to play with and adults could sit and wait with refreshments - and heat! We also collected phone numbers so that people who lived close by could wait at home and come back once their turn was approaching.

Thumbs up for health care! Who can disagree with that?

It can be difficult to estimate how many people will show up to a session of this nature and it is hard to plan accordingly but we had amazing volunteers and partners who adapted quickly and committed to help as many attendees as possible.

The outreach strategies used with our partner organizations were very successful. We implemented an advertising campaign in Spanish and Portuguese on both radio and TV to reach out to diverse communities in the area. Ilma Paixao, who leads ABR Radio, and her team were very effective not just at broadcasting the information about the enrollment session but also connecting with the communities to make them feel welcome and safe, including offering their space to host the event itself. This successful ethnic media campaign was made possible thanks to Blue Cross Blue Shield of MA and the Community Charitable Donation by Sanofi Genzyme. These outreach strategies resulted in many individuals attending who preferred to use Portuguese or Spanish as their primary language. This was not a problem for our team as we had 14 volunteers who were fluent in Portuguese and English with the remaining 5 volunteers being a mix of Spanish speakers and English speakers. 

Health care volunteers hard at work!

Some of the attendees came with questions that could be answered in 10 minutes. Other residents needed to fill out entire applications that can take an hour to complete. We were able to serve most of the people standing in line on the same day, but we knew that four hours would not suffice to meet the needs of all the community members who showed up. We had to do something to help as many as possible. We decided to call the remaining residents on the list and screen them over-the-phone to see if they needed help applying for health insurance before the end of Open Enrollment under the Health Connector. Those who qualified for Connector coverage were asked to call the HelpLine before the end of Tuesday to fill out an application. We also shared magnets with the HelpLine number with people who had questions about other kinds of coverage and asked them to connect to our enrollment experts after the 23rd to make sure that we could help those who needed to take action before the deadline. 

A busy room with a flurry of health care enrollments!

At the latest count, 782 people were served as a result of the Framingham enrollment session. In fact, that number continues to grow as more and more people keep calling into our office regarding coverage questions because they heard about HCFA through the outreach campaign for this session. Word of the event spread so far that we assisted residents from as far away as Lowell, Peabody, and even Cape Cod. This is one of our most successful events as a Navigator organization working with the Massachusetts Health Connector and with the support of the MetroWest Health Foundation. 

All smiles after enrolling in health care coverage