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MassHealth by the Numbers: The Wait List Monster, and Premiums Punish Poor Pediatric Patients

MassHealth by the Numbers: The Wait List Monster, and Premiums Punish Poor Pediatric Patients

August 26, 2005

Today we learned two numerical factoids about MassHealth that have important policy relevance:

1. The Wait List Monster - The wait list for the MassHealth Essential program (for long-term unemployed adults below the poverty line) is now around 5,400 people. This is after the program enrolled about 1,600 people off the list earlier this week, and another 1,200 people three weeks before. The wait list continues to grow, leaving thousands without coverage.

Policy relevance: The Romney health care plan assumes enrollment of all eligible people into MassHealth. Yet the Essential program, which is now capped at 43,000 people, is building up a big wait list of eligible people denied enrollment due to the enrollment cap.

Two things have to happen to get eligible people into the program. One, more money needs to appropriated for the program. Governor Romney filed his supplemental budget earlier this week, but no funds were included for MassHealth. The legislature will have to find the money to allow enrollment to grow. Will the Governor veto the appropriation? Second, the administration needs to get federal permission to raise the federal cap on enrollment. There's no reason they can't do this now, instead of waiting for the legislature to act first. So far, nothing's happened.

2. Premiums Punish Poor Pediatric Patients - MassHealth released statistics today on their members who lost coverage last year due to failure to pay premiums. The most striking number is that of the 33,773 kids that had to pay premiums to get MassHealth, more than 1 out of 20 were dropped for not paying (the number was 1749, 5.18%).

Policy relevance: Premiums were imposed on tens of thousands in MassHealth in 2003 in order to promote "responsibility" and make MassHealth more closely resemble standard insurance. Yet for low income families, even modest premiums can be a substantial hardship. Kids in particular don't pay the premiums themselves. Yet even healthy kids need regular check-ups and routine care.

The new Free Care Pool regulations proposed by the administration deny Pool eligibility to people who are dropped by MassHealth for failure to pay a premium. These kids will have no source of coverage, and may either go without needed care or face unaffordable bills. Also, RomneyCare requires new premiums from low-income families in the Safety Net Care plan. What will happen to these people if they can't make the payments each month?