A Healthy Blog

Massachusetts health care — wonky, with a healthy dose of reality

A Cheer for MassHealth -- and a Jeer for Medicaid Cost Sharing

A Cheer for MassHealth -- and a Jeer for Medicaid Cost Sharing

July 18, 2005

All the pretty ads for health plans. Even puffery for Medicare. What do you never, ever see -- ads talking about how good MassHealth is. Unthinkable. So here's a public service announcement on how MassHealth gets things right for their clients, the most vulnerable and difficult population in the Commonwealth. An article in the July/August issue of Health Affairs -- T Coughlin et al -- (sorry subscribers only -- email me and I'll send it to you) looks at MassHealth compared with 12 other states and with private health plans serving low income folks in all 13 states. Interesting results:

MassHealth US Medicaid MA Private US Priv.

Doctor Visits% 84 79 85 81
Dental Visits% 63 54 67 65
Breast Exam/Pap Smear% 53 45 43 48
Unmet Surgery/Med Need% 6 8 8 7
Unmet Drug Need% 5 10 7 7
Unmet Dental Need% 17 18 12 13

With the glaring exception of dental (helllooooooo) MassHealth compares favorably on nearly every measure with other Medicaid populations and with private health plans serving low income populations -- public and private. While there's plenty of room for improvement, let's give cheers to the folks at MassHealth and to the folks throughout our health care system who serve them. If only we had money for an ad...

Meanwhile, as the nation's governors talk about the glories of copays and other cost sharing for Medicaid clients, another Health Affairs piece (Wright et al) examines the impact of cost sharing on Oregon Medicaid . Here's what they did to the poor in Oregon -- new premiums ranging from $6 to 20 per month; new copays of $5 per office visit, $50 for emergency department, and $250 for inpatient admisssion; and elimination of premium exemptions for homeless, those with zero income, and people who experienced crime, domestic violence, natural disasters, or death in the family. And finally, a six month lockout for whose who missed even one monthly payment.

The results? A 46 percent drop in covered lives, from 88,874 to 47,957 covered lives between February and December 2003. For those who left, the vast majority became uninsured, and the principal reason for leaving was the new cost sharing.

The Governors say they want to make sure their new cost sharing proposals don't lead to clients leaving the program. Whom do they think they're kidding?</s