December 2019

December 11, 2019

Massachusetts continues to lead in children’s access to health care, however, many children and families continue to face barriers to coverage and care. Families, advocates, and policymakers recognize the need for additional improvements to ensure that all residents of the Commonwealth – particularly children and youth – can access the care they need. With this concern in mind, on July 29th Massachusetts Speaker Robert DeLeo introduced a bill known as An Act relative to children’s health and wellness (H. 4012). The bill included several policy proposals, two of which are Children’s Health Access Coalition (CHAC) priorities: ensuring continuous MassHealth coverage for former foster youth and requiring the Health Policy Commission (HPC) to study access to care for children with medical complexity, as well as a Health Care For All (HCFA) and Children’s Mental Health Campaign (CMHC) priority: improving the accuracy of provider directories, which the Senate had previously passed as stand-alone legislation this spring (S. 2295).

The Senate then introduced and passed their version of the legislation that included some variations on the provisions included in the House bill, along with several additional provisions related to the Department of Children and Families and other issues (S. 2368). A Conference Committee quickly worked out the differences and by November 20th, the legislature enacted the new version of the bill, H. 4210. Governor Baker signed the final version of An Act relative to children’s health and wellness on November 26th, making it a law in Massachusetts – Chapter 124 of the Acts of 2019.

This new law will have a positive impact on children, families, and individuals in communities across Massachusetts. Chapter 124 includes provisions similar to legislation filed by Representative Barber and Senator Lewis (H. 913/S. 610) to improve the accuracy of health insurance provider directories. Families and individuals seeking care in Massachusetts often face difficulties finding providers through their health plan’s provider directory because insurers may not regularly update their provider directories. As a result, insurance carriers appear to have adequate networks, however, upon closer inspection, a number of listed providers have moved, closed their practice, or no longer participate in a given plan – “ghost networks.” Even for providers who are still practicing and in-network, the provider directory often contains inaccurate information about the services they deliver, languages providers speak, and whether or not the provider is accepting new patients. These issues are particularly acute for families seeking behavioral health care. Chapter 124 would make short-term improvements to provider directories, including ensuring that provider directories are easily searchable, available to the public, and updated at least monthly, as well as establish a taskforce, chaired by the Division of Insurance, to make recommendations and develop regulations to make further improvements to provider directories. These provisions reflect the language agreed upon by advocates, health insurance carriers, and providers.

For some populations, the bill already had an impact even before being enacted by the legislature and signed into law. The Affordable Care Act included a provision to require states to provide Medicaid coverage to former foster youth until the age of 26, given that they were in foster care as of the age of 18, just like other young adults who are allowed to remain on their parent’s insurance until that age. However, given extensive challenges and the transient nature of former foster youth, many young adults who had “aged out” of care through the Department of Children and Families lost their MassHealth coverage for a period of time. Eligibility redetermination paperwork is sent to their last known address, at which these young adults may no longer reside causing delays or loss of coverage. If received, much of the form required them to fill out information on their income, despite being eligible for coverage under federal law regardless of income. The language included in Chapter 124 was based on legislative filed by Representative Gregoire and Senator DiDomenico requiring MassHealth to create a simplified redetermination process for former foster youth (H. 124/S. 35). In addition to the legislature, advocates are working with MassHealth to take steps to ensure uninterrupted coverage for former foster youth. Former foster youth between the ages of 18 and 26 will find it easier to maintain their MassHealth coverage by the end of 2019, due to a new system staff and leadership at MassHealth is putting into place to ensure continuous coverage for this population. The new system will protect MassHealth coverage for this population until their 26th birthday without the need to complete redetermination paperwork. This is a big step forward for former foster youth and again puts Massachusetts on the map as a leader in access to health coverage.

December 2, 2019

Massachusetts is known for its dedication to expanding access to health care, especially for the most vulnerable populations, including children. As a state, Massachusetts has led the cause by developing health coverage systems which were used as models for the Children’s Health Insurance Program (CHIP) and the Affordable Care Act (ACA). The Georgetown University Health Policy Institute Center for Children and Families (Georgetown CCF) recently released their annual report about the child uninsurance rate. This year’s report, The Number of Uninsured Children is On the Rise, compares health insurance data from the US Census Bureau’s American Community Survey from 2016 through 2018.

While children’s health coverage rates had been improving for many years prior to 2014, due in large part to the creation of programs like CHIP, the ACA further decreased the rates and number of children without insurance to their lowest levels in 2016. These programs allowed for an increase in coverage eligibility and simplification in the enrollment process. However, since 2016, children’s participation rates in Medicaid and CHIP have decreased for the first time since 2008, when participation began to be measured.

Although the state continues to lead with the lowest uninsured rate for children in the US, the uninsurance rate for the Commonwealth’s children increased by 0.2%, comparing 2016 and 2018. Our blog post on last year’s Georgetown CCF report on uninsured children highlights an increase in the child uninsurance rate even in Massachusetts – from 1% to 1.5% from 2016 to 2017. Looking at this year’s report, it appears the uninsurance rate for children in the state has actually decreased from 1.5% to 1.2% between 2017 to 2018. However, compared to 2016, the actual number of uninsured children continues to be slightly higher.

To put this in context, Massachusetts continues to lead the nation in health coverage for children. The Georgetown CCF report highlights other states where state and federal policy decisions have led to an increase in uninsured children, with no progress in moving the needle in this respect. Almost half (49.6%) of uninsured children in the US reside in just six states – Texas, Florida, California, Georgia, Arizona, and Ohio. Of these states, Texas, Florida, and Georgia have not expanded Medicaid for parents or childless adults, and there are still several other states that are “holdouts” in this regard – which can impact health coverage for children as well. The report shows one state – North Dakota – has made some progress in decreasing the child uninsurance rate.

Many factors can lead to the continued downward trend of health coverage for children during the past couple of years. The report cites the decrease in public health coverage as a major factor in the increase in uninsured children. Current federal policymakers have had a different approach when it comes to access to care. Attempts from Congress to repeal the ACA and the administration in chipping away at certain ACA protections, the repeal of the individual mandate penalty in 2017 and funding cuts for ACA outreach and enrollment have all brought a reduction in infrastructure and focus on ensuring enrollment in health coverage. Even the delayed budget extension for CHIP led to confusion among families who rely on the program about whether the benefits would continue. Researchers at Georgetown CCF believe that the increase in negative immigration rhetoric and policies on the federal level have also deterred families from enrolling their children in public benefits, including health insurance, such as parents disenrolling their eligible children despite their legal immigration status.

In Massachusetts, Health Care For All and stakeholders in the health care community are dedicated to protecting and improving access to health coverage. We also know that having health insurance does not necessarily translate into having access to care. Some health insurance comes with high costs and some safety-net programs, even for children, have caps on services and leave gaps in coverage of necessary care. That is why HCFA and the Children’s Health Access Coalition is advocating for a bill which would ensure that low-income immigrant children in our state have equitable access to coverage. An act to ensure equitable health coverage for children (H. 162/ S. 677) better known as Cover All Kids, seeks to expand comprehensive MassHealth coverage to low-income children who would otherwise be eligible except for their immigration status. This bill would help more than 30,000 children and young people in our state obtain the coverage they need, to live, learn, and thrive. If your child or the children you serve are facing barriers to accessing because they depend on the Children’s Medical Security Plan (CMSP), MassHealth Limited, or the Health Safety Net (HSN), share your story today and together we can a difference! Now is the time for Massachusetts to Cover All Kids.