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MassHealth Drops Plan to Cut Benefits

MassHealth Drops Plan to Cut Benefits

October 31, 2016

MassHealth cardMost MassHealth members have the option of either enrolling in a health plan (a Managed Care Organization or MCO) or the Primary Care Clinician Plan (PCCP). In efforts to move more members to managed care, MassHealth proposed in its 1115 waiver proposal to cut chiropractic services, eyeglasses, hearing aids, orthotics and potentially other benefits in the PCC Plan, while maintaining these benefits for members enrolled in MCOs.

Health Care For All, along with partner organizations, such as Disability Advocates Advancing our Healthcare Rights (DAAHR), the Massachusetts Law Reform Institute, and the ACT!! Coalition, as well as several provider groups, persistently opposed the proposed benefit cuts. We argued that the benefit cuts would impose barriers to care for low-income individuals and families, and violate federal Early and Periodic Screening, Diagnosis and Treatment (EPSDT) standards for MassHealth members under age 21.

In response, MassHealth first modified their proposal to maintain the full package of benefits for children and youth under age 21, while moving forward with the benefit reductions for adult PCC Plan members. However, at their public meeting in October, MassHealth announced their decision to drop the PCC Plan benefit cuts altogether.

We commend MassHealth for making the right decision, and thank our advocacy partners for making this issue a priority.

The next hurdle is cost-sharing. MassHealth is moving forward with their request to charge higher copays to members enrolled in the PCC Plan as compared to those enrolled in MCOs or a new Accountable Care Organization (ACO) option. MassHealth also seeks to apply copays to additional services (currently MassHealth members only pay for prescription drugs), including use of the emergency room for non-emergent conditions. These cost-sharing policies are slated to go into effect in 2018, after a public process.

For low-income people using MassHealth to stay healthy, even modest copays can be barrier to getting the care they need. In the long run, this can make overall care more costly. We urge MassHealth to carefully consider the impact on health and the cost-effectiveness of adding more copays.

                                                                                                                                -- Suzanne Curry