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A Healthy Blog

Massachusetts health care – wonky with a dose of reality

January 13, 2014

HPC slide showing major components of cost trends report

The Health Policy Commission (HPC) met Wednesday, January 8, for its first meeting of 2014.  Following suit from the last full meeting, the 2013 Cost Trends Report was a main topic of discussion. Also on deck was a presentation about the award recipients for the Community Hospital Acceleration, Revitalization, and Transformation (CHART) program and an update on the registration of provider organizations.

Materials from the meeting are here, and our full report is on the back side.

January 10, 2014

Today’s Connector Board meeting focused on open enrollment progress, IT issues and coverage workarounds. The Connector leadership expressed a strong commitment to extending coverage to everyone eligible, without gaps and delays. At the same time, they acknowledged continuing problems with the IT, both the website and the eligibility processing systems. They are determined to find solutions and seek accountability for the deficiencies.

The meeting attracted more press than the Connector has seen in a long while, with a lengthy media scrum after the meeting. Coverage included the Springfield Republican, andSpringfield’s channel 22, and the Boston Globe and Herald. Materials from the meeting are posted here. Our full report is coming right up:

January 10, 2014

For years advocates have worked to share a message that Massachusetts knows well: Oral health is critical to overall health, and dental insurance is health insurance. The messaging looked like it would pay off when dental coverage for children was mandated by the ACA as one of 10 Essential Health Benefits that must be offered by compliant insurance plans. However, as illustrated by this NPR story, the route to expanded access to quality, affordable children’s dental coverage is not as foolproof as one would hope.

NPR’s Julie Rovner reports the gaping loophole present in the new law. Families aren’t required to buy dental coverage for their children when shopping through states’ health care marketplace exchanges. Though the coverage is technically mandated, there are no penalties for families who do not purchase it.

Further, the process by which families obtain pediatric dental coverage presents obstacles in and of itself that could impede families’ access to coverage. These obstacles are twofold: structural confusion and cost.

Both exist in Massachusetts, despite our Connector’s strong support for dental plans.

Because some plans in the marketplace include embedded pediatric dental coverage, while other plans require that coverage be purchased separately, there exists an underlying confusion and inconsistency. Secondly, because these stand-alone dental plans are not eligible for federally-sponsored subsidies, families face an economic disincentive to buy such plans—and the most vulnerable families (namely those with particularly tight budgets) may not be able to afford them at all.

With 1 in 10 children from low-income families suffering from untreated dental problems, the issue of access to dental care is both immediate and widespread. Though the ACA has laid a strong foundation by declaring children’s dental coverage one of its 10 essential benefits, there remains much to be done to ensure that the oral health needs of children across the state are equitably met.

-Jene Bass and Courtney Chelo

January 8, 2014

Two Upcoming Events of Interest:

The MA Department of Public Health has been holding a series of Community Health Dialogues around the state to talk about the work and priorities of the Department and hear from community members about their work and their concerns/suggestions for DPH. The final dialogue is taking place this Friday, January 10, 9:30-11:00am, at the Carter Auditorium in Boston. Learn more here.

Also, the Schwartz Center for Compassionate Healthcare is holding a free webinar as part of its Compassion in Action webinar series on Tuesday, January 14, 4:30-5:30, titled “Yes, Empathy Can be Taught!” Learn more and register here.

  – Deb Wachenheim

As part of the ACA in 2014 Medicaid Will Expand Eligibility to Include More Low-Income Adults - adds parents and Adults
January 1, 2014

Raise a glass and sing Auld Lang Syne to remember two historic MassHealth programs that are ending today.

New Years Day 2014 brings profound changes to MassHealth, our Medicaid and CHIP program. These changes will transform the program as much as the changes that accompanied the creation of MassHealth, in 1996.

The national transformation will be even more dramatic, as starting on 1/1/14, the ACA allows all states to set Medicaid eligibility based solely on income. And, as usual, it all starts with Massachusetts.

MassHealth is built on a federal waiver originally granted to the Commonwealth in 1996. It allowed the state to begin to break out Medicaid from its traditional role as the health program that goes along with welfare. Cash welfare benefits generally go to 4 groups, and these were the ones eligible for Medicaid before 1996: the elderly, children, parents, and those with disabilities. The 1996 MassHealth reform allowed more parents and children to become eligible. Even more revolutionary was eligibility for adults who were not parents, under a new program called MassHealth Basic.

MassHealth Basic was originally set up to cover what Judy Meredith affectionately called “bums in the street,” adults with below-poverty incomes who had been out of work for the past year. Because the program was a federal experiment, the state was given the ability to reduce benefits, cap enrollment, and even eliminate the program to control expenses.

So in April, 2003, eligibility for the program was reduced as then House Speaker Tom Finneran demanded deep budget cuts in health care programs. Over 36,000 people lost coverage. HCFA launched a furious campaign to restore the program, and in October, 2003, the program was brought back to life. The replacement coverage program (with further reduced benefits) was called MassHealth Essential, as lawmakers tried to come up with an even stingier adjective than “basic.”

But budget concerns again led to the Romney administration to cap enrollment in 2005. Eventually 12,000 people languished on the waiting list, eligible for coverage, but with no slots to allow them to enroll. We insisted that the broad health reforms then being negotiated include ending the waiting lists for MassHealth Essential. The final version of Chapter 58 (“RomneyCare”) included the provision ending the enrollment cap (section 107).

Source: excerpt of Kaiser Family Foundation chart

Source: excerpt of Kaiser Family Foundation chart

Starting today, the ACA lets all states choose to offer Medicaid  based solely on income. That provision builds on a model pioneered in Massachusetts.

Here, MassHealth Basic and MassHealth Essential are ending today, to be replaced by a new program, called MassHealth CarePlus. Many people formerly in Commonwealth Care will also get their coverage through CarePlus. Here’s a MassHealth guide to CarePlus, and a general FAQ on changes to the MassHealth program for 2014 under health reform.

(Also ending today is the Medical Security Program, which dates back to the 1988 Dukakis universal coverage law and provides coverage to people receiving unemployment insurance, and the insurance partnership program, a Weld administration-era program for workers in small companies that never took off the way Charlie Baker envisioned.)

We’re pleased that CarePlus will simplify and unify various flavors of MassHealth into a more rational program design, so we’re not sad to see Basic and Essential go away. Their tortured history represents the long struggle for expanding health care to those with no other source of coverage.

As one of the models for the ACA’s Medicaid expansion, MassHealth Basic will lead to coverage for as many as 10 million people nationally in the states that choosing the expansion. Another 3.6 million eligibles live in states that are not expanding coverage now.

Open late neon sign
December 30, 2013

Ring in the new year with coverage. From the Health Connector:

In an effort to give applicants every opportunity possible to complete an application for health insurance coverage starting in January, the Health Connector’s customer service center will be open for expanded hours on Tuesday, December 31. For assistance on an application, call (877) 623-6765, from 7 a.m. through 9 p.m.

December 30, 2013
Dec 30 blog post photo

The season of giving is almost over and there are only two days left to donate to Health Care For All in 2013.

Please help us provide health care education, enrollment services, and advocacy that the people of Massachusetts deserve. In order to continue the important work we do and improve the quality and accessibility of health care for all Massachusetts residents, we depend on your generosity.

We invite old and new friends to consider making a gift today.

If you have not already made a donation to our annual fund and appreciate the work we do, please help out.

To make a tax-deductible donation:

• Click here to make an online donation
• Mail a gift to: Health Care For All, 30 Winter Street, Boston, MA 02108
• Dial a pledge at 617-275-2926

Celebrate and Remember
What better way to celebrate family and friends than to give a gift to HCFA in their honor or memory? Click here to make a donation or call 617-275-2926 to give today!

Online Giving Made Easy!
Make a contribution to HCFA via Network for Good. Simply select Health Care For All as your charity of choice.

Matching Gifts
Many corporations provide a 1:1 matching gift for their employees who donate to nonprofits. Please contact your Human Resources department today.

Monthly Donations
Support HCFA monthly by allocating an ongoing donation. Giving a specific amount each month has great impact on our work. Email freitas@hcfama.org to start the process today!

Workplace Giving
Join your employee giving program or encourage your company to become part of one. HCFA is a part of Community Works, the Commonwealth of Massachusetts Employees Charitable Campaign (COMECC # 111147) and the City of Boston Employees Charitable Campaign (COBECC #2015).

Thank you again for considering a donation to Health Care For All.  Because of your generosity, HCFA’s good work can continue.

December 24, 2013

Connector Deadline Extension 12-23-13

The Health Connector has just extended the deadline for many people to either select a plan and make their first premium payment. The Connector's release is here (bettermahealthconnector.org/application-deadline-extension/). (UPDATE: See the latest enrollment Q and A with Connector spokesperson Jason Lefferts on the 12/26 WBUR Commonhealth Blog) Headlines:

  • The new deadlines are Tuesday, December 31, to select a plan, and extended deadlines that give members additional time to make a payment.
  • For ConnectorCare members (people who receive state subsidies and federal tax credits, generally between 138% and 300% of the federal poverty level) who have completed an application and received a plan selection notice, they have until December 31 to pick a health plan. These members may not immediately be in the carrier’s system if a member contacts the carrier to check their status, but services used within the plan’s network will be covered starting January 1. ConnectorCare members will receive their first bill in January, which will request payment for both January and February premiums.
  • For Health Connector members who are receiving only federal premium tax credits as a subsidy (generally between 300% and 400% FPL), they also have until December 31 to pick a plan and pay their first month’s premium. If they need more time to pay their first month’s premium, they will be automatically enrolled in temporary coverage for the month of January, with the new plan taking effect on February 1, assuming payment is made.
  • For those who are purchasing health insurance with no financial assistance (former Commonwealth Choice), the deadline to pick a plan is December 31, with a deadline of making the first premium payment by January 10.  Coverage will not be effective until payment is received, and it may take about five business days after payment is received until the policy is reflected in the carrier’s system. However, these members will be eligible for retroactive coverage to January 1 when the payment is made and the carrier processes the enrollment. Payment by electronic fund transfer can be done only if the member takes that step immediately after plan selection. Otherwise, the member must mail a check or money order to the Health Connector, or visit the walk-in offices in Boston or Worcester.
  • Unprocessed applications seeking financial assistance will be placed in temporary coverage until the application is processed. Letters to those members will be mailed starting this week.

The Commonmwealth Fund's David Blumenthal had a smart observation today about these deadlines slipping:

The changing dates associated with the ACA are troubling to some, since they suggest confusion and even mismanagement by the Obama administration. It would obviously be reassuring if every declared date were honored and announced rules and intentions never changed. On the other hand, I’m doing some long-delayed repairs in my home. The contractor said the work would be done by Thanksgiving, but there were unanticipated problems. We’re hoping now for Christmas.  I’ll be happy if it’s done by mid-January, but the key thing is whether, a year from now, I’m satisfied with the result. Health insurance is obviously way more important to millions of Americans than any home repair project could ever be. But few things in life go exactly as planned, and it would be totally astonishing if the implementation of massive reforms to a sector accounting for 20 percent of our economy rolled out without a bump or a detour.  We should keep that in mind as we think about those changing ACA deadlines.

Click on for the full detailed Connector update:

Holiday appeal
December 23, 2013

As we approach the last days of 2013, please consider making a donation to Health Care For All. Below are the ways that you can support our efforts to ensure that everybody has high quality, affordable healt

Holiday Appeal

h care. What better way to celebrate family and friends than to give a gift to HCFA in their honor or memory? Click here to make a donation or call 617-275-2926 to make a pledge! Make a contribution to HCFA via Network For Good. Simply select Health Care For All as your charity of choice. Support HCFA monthly by allocating an ongoing donation. giving a specific amount each month has great impact on our work. Email freitas@hcfama.org to start the process today! Join your employee giving program or encourage your company to become part of one. HCFA is a part of Community Works, the Commonwealth of Massachusetts Employees Charitable Campaign (COMECC #111147) and the City of Boston Employees Charitable Campaign (COBECC #2015). To make a tax-deductible donation:

Click here to make an online donation

Mail a gift to: Health Care For All 30 Winter Street, Boston, MA 02108 Attn:Development Dial a pledge at 617-275-2926 Thank you for all of your continued support!

December 23, 2013

Economist Uwe Reinhardt has an apt description of how the complete lack of information around health insurance prices feels to consumers:

“Imagine a department store whose customers are blindfolded before entering. A shopper might enter the store seeking to buy an affordable dress shirt and a tie, but exit it with a pair of boxer shorts and a scarf. Sometime later, he would receive an invoice, whose details would be incomprehensible to him, save for one item: a dollar amount in a framed box with the words: “Pay this amount.”

Massachusetts is beginning to move away from this opaque-world and enter into transparencyland. A week ago, the Division of Insurance (DOI) issued a bulletin regarding the consume price transparency provisions that apply to health insurers as part of Chapter 224, the 2012 cost control and delivery reform law. The law states that Massachusetts health insurers must provide a toll-free number and website that enables consumers to obtain within 2 days the estimated or maximum allowed charged for a proposed admission, procedure or service, and the estimated amount the patient will be responsible to pay. Insurers will have to provide these estimates in real time by October 1st, 2014. Insurance carriers now have to tell you how much your health care costs, before you receive it. Through this bulletin, the DOI has provided more guidance on what insurers must do to comply with this law. The bulletin states that the DOI expects the following:

  • All systems must be consumer friendly.
  • Insurers must provide the anticipated charge and a consumer’s anticipate out-of-pocket costs for an admission, procedure or service based on general information available to the insurer at the time the consumer makes the request. The DOI recognizes that in some cases a insurer may not be able to obtain all the information necessary to provide a cost estimate to a consumer in one conversation and states that the “2 day” timeline will begin when the insurer has all the necessary information.
  • Although insurers can request more information from consumers, insurers do not need perfect information to provide a cost estimate, including and especially diagnostic or procedural codes. Consumers should not be required to provide the insurer with a “CPT code” to get a cost estimate.
  • If a CPT or diagnostic code is necessary to obtain a cost estimate, the insurer, with the consumer’s permission, should be responsible for obtaining it from the consumer’s health care provider.
  • Consumers should provide insurer with as much information as possible and insurers should request information that is minimally burdensome for the consumer to acquire.
  • The cost estimate can be provided via conversation, email or writing.
  • The insurer must provide the consumer with the anticipated total cost and the consumer’s out-of-pocket cost based on the available information at the time the request is made.
  • If the consumer wishes to do some comparison shopping and requests the cost estimate for more than one provider, the insurer must provide it in a clearer and easily comparable manner.
  • Insurer transparency tools must provide information for those who are visually impaired or otherwise unable to access information being provided by a insurer through its website or by telephone, or do not speak English as a first language.

We welcome this bulletin and congratulate the Division of Insurance and the Office of Consumer Affairs & Business Regulation for issuing the guidelines. As deductibles become more entrenched in our insurance design, consumers need a way to know the cost of the health care services they receive. Insurers must create transparency tools that are user friendly, clear, accessible and most importantly do not require consumers to have complex CPT or other codes on hand.