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A Healthy Blog

Massachusetts health care – wonky with a dose of reality

May 10, 2018

By Kate Ginnis, MSW, MPH, Director of Behavioral Health Advocacy & Policy, Boston Children’s Hospital


Children in Crisis

One in five children suffers from a diagnosable mental health disorder.  Half of all lifetime cases of mental illness are diagnosed by age 14.[i]  The prevalence of mental health disorders among children and adolescents indicates the need for a robust treatment system that allows families to access appropriate care for their children when and where they need it.  Any parent who has tried to get care for their child knows that it is not that simple.

Kids and Families in Crisis

Children with mental and behavioral health disorders and their families across Massachusetts are in crisis. Nowhere is it more evident than in Emergency Rooms throughout the Commonwealth, where parents and caregivers bring their children when they are having a behavioral health emergency.  As with any patient in the ER, children are evaluated by professionals who make recommendations about the best next step, which may include inpatient psychiatric care, an intermediate level of care, or outpatient care.  The similarity between what happens in the ER for youth with physical health conditions and those with behavioral health conditions stops there.  For children with physical health conditions, more complex conditions with more acute symptoms warrant the most immediate and most intensive care.  For children with behavioral health conditions, the most complex patients are more likely to spend days or even weeks in the ER awaiting care.[ii]  Psychiatric “boarding,” was first observed in 2000,[iii] and has been a problem for youth and their families ever since.  Most days in Massachusetts, there are children sleeping in EDs because they cannot access the care that they need.

Why is there a boarding crisis?

Psychiatric boarding is the most severe and apparent symptom of the inadequacies in access to behavioral health care that the Children’s Mental Health Campaign (CMHC) has prioritized for more than a decade.  In 2006, the CMHC was launched with the publication of a paper entitled, “The Time is Now,” which laid out a set of recommendations to improve children’s mental health care in Massachusetts.  Since that time, the CMHC, a coalition of advocates led by the Massachusetts Society for the Prevention of Children, Boston Children’s Hospital, the Parent-Professional Advocacy League, Health Care for All, Health Law Advocates and, more recently, the Massachusetts Association for Mental Health, has advocated with leaders in Massachusetts to make substantial policy changes to improve access. 

Though we understood that boarding was indicative of a larger system failure, the CMHC leadership realized that in order to advocate for much-needed change, we needed to better understand what was driving the problem. Over the past three years, the CMHC embarked on a research project funded by the CF Adams Charitable Trust to look at boarding from the perspective of hospitals, families, and the community.  We knew that this problem was multi-faceted and that we needed a multi-pronged solution.  We wanted to make sure that we understood both the data and the family experience in order to identify essential policy changes that would have real impact. 

Our research elucidated a trend that we knew existed but for which we previously had mostly anecdotal evidence: youth with more complexity board longer.  In December 2016, the CMHC brought together key stakeholders at a pediatric boarding “summit,” to present project outcomes and to get feedback from key stakeholders which enabled us to develop a plan for next steps in legislative, administrative, and budget advocacy to eliminate boarding.  At the same time, the Executive Office for Health and Human Services, with the leadership of Secretary Marylou Sudders, embarked on a statewide workgroup to solve the boarding problem for both children and adults.  CMHC leaders have been delighted at the attention paid to this critical issue and have been engaged at every step of the way.  Perhaps the most immediate result of our collective work is the creation of inpatient units to treat youth with Autism Spectrum Disorders who are in psychiatric crisis, the first of which will open later this year.

What’s next?

Boarding as a symptom allowed the CMHC leadership to unpack several other advocacy priorities that we believe will improve access at all levels of the mental health care system, and that you can read about on the CMHC website or by subscribing to our monthly newsletter. New issues are brought to our attention by the advocacy of our engaged providers and families, and we depend on your insight, expertise, and activism to combat the inequities that exist in the children’s behavioral healthcare system. Contact the CMHC or you may contact me directly at kate.ginnis@childrens.harvard.edu.


May 9, 2018


By Marisol Garcia, Esq., Director/Managing Attorney,

Mental Health Advocacy Program for Kids, Health Law Advocates

On a spring day in 2017, elementary school staff called an ambulance to transport Ashley—a fourth grader experiencing an acute mental health crisis—to the emergency room. In the ambulance, Ashley hit an EMT in the face. As a result, charges were pressed against Ashley for assault and battery. Ashley’s mother was shocked when she received court documents instructing her that her nine year old daughter had a clerk’s magistrate hearing. Ashley would have to appear in court in a delinquency proceeding for behavior that happened while her family and providers were actively seeking treatment for her mental health needs.

Just like Ashley, many children involved in—or at risk of entering—the juvenile justice system end up there because of unmet mental health needs. Health Law Advocates’ Mental Health Advocacy Program for Kids (MHAP for Kids) has a proven track record of significantly improving the lives of these children and their families while also reducing unnecessary costs for the Commonwealth.

MHAP for Kids embeds staff attorneys in Family Resource Centers (FRCs) in Lowell, Lynn and Boston. The state created the statewide network of FRCs in 2012 with the goal of increasing children’s access to mental health care, special education and other services that play a significant role in diverting children from juvenile court. Our attorneys are trained in overcoming systemic barriers to mental health services by working with young people and their families to begin or improve special education services, secure and/or coordinate community-based mental health services, collaborate with the Department of Children and Families, the Department of Mental Health and the Department of Developmental Services, advocate for general education accommodations and assist with health insurance coverage.

MHAP for Kids serves young people and parents who have a “significantly elevated risk profile.” Of the children served:

  • 83% diagnosed with one or more mental illness (average of 3.5 mental health related conditions)
  • 89% experienced a barrier to mental health treatment
  • 63% accessed crisis or emergency mental health care services in the past year
  • 44% hospitalized for psychiatric care in the past year
  • 37% admitted to a residential mental health facility in the past year
  • 28% did not attend school at all or missed almost every day in the past three months
  • 61% missed school more than one day per week in the past three months

MHAP for Kids works. The Boston University School of Public Health conducted a two year study on the efficacy of MHAP for Kids. The study found that when MHAP for Kids intervenes in a child’s life, children experience:

  • Improved school attendance (31% missing more than one day per week, reduced to 6%)
  • Decreased use of emergency mental health services (70% with recent need, reduced to 24%)
  • Lowered use of overnight hospital stays (44% with recent need, reduced to 14%)
  • Reduced use of emergency shelters (10% with recent need, reduced to 0%)
  • Improved families’ self-reported mental health (children and parents/guardians), family conflict and family difficulties

In Ashley’s case, her therapeutic providers contacted the MHAP for Kids staff attorney immediately. The attorney felt strongly that Ashley was being punished for her unmet mental health needs. The attorney explained the entire juvenile court procedure to both Ashley and her mother so that they would know exactly what to expect. At the hearing, the attorney explained to the magistrate that Ashley is working with MHAP for Kids to get her the mental health treatment that she needs. The magistrate dismissed the charges. The MHAP for Kids attorney helped Ashley find placement in a therapeutic day school. Today Ashley is attending classes successfully and learning new coping skills.

MHAP for Kids is a lifeline – out of the juvenile justice system and into the treatment and care that creates brighter futures. As MHAP for Kids expands, it is our hope that one day soon, this program will be available to every Massachusetts child in need of its services and support.

This blog is part of HCFA’s Children’s Mental Health Week series.

May 8, 2018


By Danna Mauch, PhD, President & CEO, Massachusetts Association for Mental Health

Early childhood mental health care matters. One out of every seven children, ages two to eight years, was reported to have a diagnosed behavioral or developmental condition (e.g., depression, anxiety, behavioral or conduct disorder, autism spectrum disorder, developmental delay, etc.) in the National Survey of Children’s Health.[i] Reaching children and families early is critical to optimizing opportunity over the life course, and the pediatric medical home is an effective point of entry for behavioral health as it is a non-stigmatized and trusted source of care.[ii] The Massachusetts Association for Mental Health (MAMH) advocates for widespread adoption of evidence-based models of early childhood mental health (ECMH) integration in pediatric primary care to improve access and outcomes for children and families.

How does ECMH integration in primary care work?

LAUNCH/MYCHILD is one example of an evidence-based model of early childhood mental health (ECMH) integration in pediatric primary care. This model includes both a mental health clinician and a family partner (an adult experienced in navigating the health and social services systems for his/her own child) embedded in the primary care team. The behavioral health clinician and family partner attend regular team meetings and case conferences, participate in daily huddles, receive children and families by way of warm hand offs from primary care clinicians, and are integral in the development of care plans. The goals of this model are to promote healthy relationships between parents/caregivers and their children, prevent concerning behaviors, reduce stress on families, identify behavioral health concerns early and make referrals for therapeutic intervention.

What is the evidence for LAUNCH/MYCHILD?

In my former role as Senior Fellow/Principal Associate at Abt Associates, I led an evaluation of MYCHILD; likewise, the Institute for Urban Health Research at Northeastern University led an evaluation of LAUNCH. As measured by evidence-based tools, LAUNCH/MYCHILD resulted in statistically significant reductions in parental stress and depression symptoms, as well as improved child mental health and social emotional wellness. The Abt research team additionally used Medicaid data to compare health care expenditures for children enrolled in MYCHILD with a matched comparison group in the MassHealth population. Looking at all MassHealth costs over a 12 month period following the index date, we found that MYCHILD costs were $164.21 less per child per month versus children in the control group. Likewise, children enrolled in MYCHILD were also more likely to receive appropriate, non-stigmatizing diagnoses.[iii] Accurate diagnoses are essential to developing effective care and treatment plans.  

Are there other evidence-based models of ECMH integration in primary care in Massachusetts?

Yes, there have been additional investments in ECMH integration in pediatric primary care that have further contributed to a body of knowledge in this field. The MetroWest Health Foundation, for instance, supported the Southborough Medical Group in implementing pediatric integrated behavioral health care. The result was improved access to behavioral health services (both timeliness of care and engagement in care). Southborough was also able to address language and cultural barriers to care and document improved communication between families and providers.

Related, the Pediatric Physicians’ Organization at Children’s (PPOC) has successfully integrated mental health care throughout its practices. PPOC also received a grant from the Blue Cross Blue Shield of Massachusetts (BCBSMA) Foundation to integrate substance misuse services in pediatric primary care through a partnership with the Adolescent Substance Abuse Program (ASAP) at Children’s; the Foundation has secured John Snow, Inc. to analyze the impact of the model on access to care. Furthermore, the Richard and Susan Smith Family Foundation’s TEAM UP for Children Initiative is supporting transformation to integrated pediatric primary care at three federally qualified health centers. The Smith Family Foundation is partnering with the Robert Wood Johnson Foundation and Boston University on an evaluation of the initiative to assess real-time cost and quality outcomes.

How can these models be brought to scale?

Despite support for ECMH in primary care from diverse stakeholders, public and private investments in practice transformation and a growing evidence base, integrated pediatric behavioral health care is far from universal. The promotion of widespread adoption, implementation and sustainability requires a multifaceted approach including addressing policy and regulatory barriers; investing in training and technical assistance for practice transformation; promoting sustainability through delivery and payment reform efforts (such as reimbursement for core elements of integrated care and review of ACO certification/reporting requirements); and enforcing state and federal parity laws.

May 7, 2018


By Liz Belfield, Program Manager, Parent/Professional Advocacy League

Children’s Mental Health Week (CMHW) was started in 1991 by a group of families in Missouri, now called Missouri Families 4 Families, who wanted to fight discrimination and stigma in their community. The Parent/Professional Advocacy League (PPAL) supported these families and this idea, bringing CMHW to Massachusetts in 1996 to do the same –fight stigma and promote family wellness in communities.

We use this metaphor of ‘fighting’ stigma because for a lot of our families, it is a fight. When parents come to us for help, we tell them we will train them to be advocates, but what is an advocate but a fancy word for fighter? Advocates push issues forward, advocates support policies that help them, advocates fight for their causes. The parents who come to us for support already know how to fight. They’ve been fighting for their children since day one. What we teach them is how to channel their parental instincts, their internal protective mamma and papa bear- ness, into meaningful action that causes positive change for their children.

And a lot of what these parents are fighting is stigma. Stigma is so harmful in so many different ways. It has been shown to have a profound effect on a person’s sense of self and can diminish their self-esteem and confidence. Children and young people have been shown to experience higher levels of stigma than adults. Stigma is so pervasive. It doesn’t just affect the individual, but their family and friends, their school teachers and peers, their community leaders and health care professionals. Stigma can restrict access to services and the services themselves. In fact, the former US Surgeon General, Vivek Murthy, stated that stigma is one of the most important problems facing the entire mental health field.

On average, individuals wait 8-10 years from when mental health symptoms emerge to when they seek help. Can you imagine someone waiting 10 years for cancer treatment or 10 years for a heart transplant? This lag in help isn’t due to not needing help, but not knowing how to get help or being afraid to get help. When those struggling with mental health challenges are portrayed as violent, unpredictable, or ‘crazy,’ it’s not hard to imagine why they wait so long to get help. Unfortunately, those individuals are more likely to be the victims of violence, rather than the perpetrators. Stigma is preventing individuals from getting help, which could cost them their life.

Mental health stigma is literally killing people. Not through the tragedies broadcast on the news, but through suicide. Suicide is the 10th leading cause of death in the US, the 3rd leading cause of death in children aged 10-14, and the 2nd leading cause of death for youth aged 15-24. In fact, more young adults die from suicide than from cancer, heart disease, AIDS, birth defects, stroke, pneumonia, influenza, and chronic lung disease COMBINED. And rates in minority and LGBTQ communities are worse. Native American teens have a suicide death rate that’s twice the rate of Caucasian teens and for LGBTQ aged 10-24, suicide is one of the leading causes of death.

This is happening all over the country, all over the world, and our little Commonwealth is not immune. Massachusetts is higher than the national average at 11% of youth reporting experiencing at least one major depressive episode in the past year, and suicides in Massachusetts increased 40% from 2004 to 2014. In 2014, there were 608 recorded suicides, more than homicides and motor vehicle deaths combined. And that number is only rising.

Another concerning statistic is that while 55% of people who died by suicide in 2015 were in the middle of a mental health problem, only 39% were receiving services or treatment for mental health or substance use. Why aren’t individuals getting treatment for their mental health? Why is there a 10 year lag between symptoms and treatment? Why are we letting this issue hurt our families, friends, and neighbors?

We need to change the way we think about mental health and talk about mental health. Books and articles don’t have as much impact on the way we think as the people around us do. When you stand up and say something, you give permission to others to say something too. We need to create a culture where mental health can be talked about productively and openly. We need to create places that people can go to receive help without judgement or shame. We need to talk about how mental illness is not a sign of weakness but how seeking and accepting help is a sign of strength.

Families fight stigma because they are fighting against institutions and red tape that prevent their children from getting the care they need. They are fighting against negative connotations that cause their children actual harm. They are fighting against whispered words and dirty looks that make their children feel like mental illness is shameful. They are fighting against fear, against prejudice, against discrimination, against hate. But mostly important, they are fighting for something – for access to care, for a safe place in their communities, and for their children to have a chance to change their futures for the better.


This blog is part of HCFA’s Children’s Mental Health Week series.

May 4, 2018

In just a few days, children and youth, families and advocates will light up the Commonwealth in green to celebrate Children’s Mental Health Week (CMHW). This year’s theme is Supporting Families, Changing Futures. The Parent/Professional Advocacy League (PPAL), the Massachusetts Family Voice for Children’s Mental Health, explains the crucial interconnection between supporting families and improving children’s futures: data shows that children do better when they are with their families, in their communities and that supported families have access to more resources, advocate for their children’s needs more effectively, and enhance their skills as unique and talented caregivers. Finally, PPAL reminds us that by treating and keeping children in their communities, we can support families more effectively and change children’s futures for the better.

Improving access to mental health care for children and youth is a central component of Health Care For All’s work to create a Commonwealth in which everyone has the equitable, affordable, and comprehensive care they need to be healthy. While we can be proud that Massachusetts has the highest rate of children enrolled in health insurance coverage of any state in the nation, too often children and adolescents remain unable to access the mental health care they need when and where they need it. As a result, barriers to effective and appropriate treatment and care persist:

  • One in five youth (ages 13-18) have, or will have, a serious mental illness.
  • About 50% of students age 14+ living with a mental health challenge drop out of high school. This is the highest dropout rate of any disability group.
  • 71% of youth and young adults with substance use disorders also experience a co-occurring mental health disorder
  • African Americans and Hispanic Americans use mental health services at about half the rate of whites in the past year and Asian Americans at about 1/3 the rate

Health Care For All (HCFA) is proud to serve on the Executive Committee of the Children’s Mental Health Campaign (CMHC), working alongside the Massachusetts Society for the Prevention of Cruelty to Children (MSPCC), Boston Children’s Hospital (BCH), the Parent/Professional Advocacy League (PPAL), Health Law Advocates (HLA) and the Massachusetts Association for Mental Health (MAMH) to reform the children’s mental health care system in Massachusetts and lay the foundation for a comprehensive and coordinated system of evidence-based mental health prevention, diagnosis and treatment that is accessible to all children, adolescents and families.

To mark CMHW 2018 next week, HCFA will welcome a guest blogger from each of these organizations to highlight the challenges and opportunities in children’s mental health and the work we are doing individually and collectively to increase access, support families and change futures.

Please join us as we promote awareness about children’s mental health and work together to reduce stigma!


This blog is part of HCFA’s Children’s Mental Health Week series.

By Natalie Litton, Policy & Project Coordinator, Health Care For All
April 20, 2018

In April, advocates across the country mark Medicaid Awareness Month and celebrate the program that provides health coverage to millions, including eligible low-income adults, children, pregnant women, elderly adults and people with disabilities.

Here in the Bay State, approximately 1.8 million people depend on MassHealth – the Commonwealth’s combined Medicaid and Children’s Health Insurance Program (CHIP) – to access the health care they need. From birth and well-child visits to annual physicals, substance use disorder treatment and long-term care, Medicaid is a lifeline across the lifespan.

In Massachusetts, adults up to 138 percent of the federal poverty line are now eligible to enroll in Medicaid, and 40 percent of children rely on MassHealth for coverage. Nationally, Medicaid pays almost $4 billion annually in school-based health services. Schools depend on these funds to connect students with vital health resources – 68 percent of school superintendents said that they utilized these funds to keep nurses, counselors, and speech therapists on staff.

Medicaid supports 61 percent of the Bay Staters who live in nursing homes and 33 percent of Massachusetts seniors and people with disabilities have health coverage through Medicaid. Medicaid helps many seniors pay for long-term care and support at home that allows them to continue living in their communities.

Medicaid coverage is at the forefront of the national effort to fight the opioid crisis. Nationally, Medicaid covers one in four Americans with an opioid use disorder. Here in Massachusetts, Medicaid pays for 49% of the Commonwealth’s buprenorphine expenditure, a medication used to treat opioid addiction.

For more on the many ways that Medicaid supports the health of vulnerable populations, please visit Community Catalyst’s blog:

The Blue Cross Blue Shield of Massachusetts Foundation’s recent report MassHealth: The Basics provides an in-depth look at Massachusetts’ combined Medicaid and Children’s Health Insurance Program (CHIP).

During this Medicaid Awareness Month, all of us at Health Care For All re-commit ourselves to the urgent work of protecting Medicaid against ongoing threats and to raising awareness of the integral role this program plays in creating a future in which health care access is a reality for all.

-Natalie Litton

April 20, 2018

On April 23, the Massachusetts House of Representatives will begin voting on the state’s budget for fiscal year 2019, which begins on July 1 of this year. Representatives will consider 1400 amendment proposed by Representatives, including a number of important health-care related amendments.

HCFA is supporting a number of amendments that will improve access to affordable and quality health care coverage; there are also some proposed amendments we oppose that would move us backwards.

With debate in the House starting, it is crucial that your Representative knows how constituents feel about these critical health care related amendments. To find your State Representative’s contact information, click here.  A summary of these key amendments is below:

[For full explanations of each amendment, see our complete budget amendment fact sheet here]

HCFA Supports:

Health Insurance:

Amendment #1268 (Insurance Provider Directories): Sponsored by Rep. Barber, establishes comprehensive requirements on health plans to make accurate provider directories available to the public.

Oral Health:

Amendment #580 (Periodontal Coverage Restoration): Sponsored by Rep. Scibak, adds language and $12 million (over half federally reimbursed) to MassHealth to reinstate coverage for periodontal services for adult MassHealth enrollees.

Amendment #976 (DPH Office of Oral Health): Sponsored by Rep. Hogan, is a no-cost amendment that removes an earmark to free up sufficient funding for the operation of DPH’s Office of Oral Health.

Amendment #812 (Dental Program for Children): Sponsored by Rep. Cahill, funds the Forsyth Kids program at $300,000, level-funded from FY2018.

Prescription Drugs:

Amendment #557 (Academic Detailing Initiative): Sponsored by Rep. Benson, adds language and $500,000 to fund a physician education program on cost-effective ways to manage pain without opioids, administered by the Health Policy Commission.

Amendment #1285 (Ban Drug Company Marketing “Coupons”): Sponsored by Rep. Barber, reinstates the state’s prohibition on drug industry marketing “coupons” by 2019.

Amendment #620 (MassHealth Drug Cost Control and Transparency): Sponsored by Rep. Jones, authorizes MassHealth to negotiate cost-effective drug prices, and receive pricing information if no agreement can be reached.

Children’s Health:

Amendment #247 (Infant and Early Childhood Mental Health): Sponsored by Rep. Balser, would provide $125,000 to support collaboration activities of the Department of Mental Health and the Department of Early Education and Care.

Amendment #473 (Mental Health Advocacy Program for Kids): Sponsored by Rep. Golden, would provide $200,000 to maintain MHAP for Kids.

Amendment #1172 (Expansion of Return to School “Bridge” Programs): Sponsored by Rep. Campbell, would provide $250,000 to expand these bridge programs.

Amendment #198 (Protecting Medically Complex and Fragile Children): Sponsored by Rep. Dwyer, would provide an additional $16 million investment in the Continuous Skilled Nursing Program.

HCFA Opposes:

Amendments #116 and #339 (MassHealth Control Board): Sponsored by Reps. Lombardo and Lyons, set up a MassHealth Control Board with broad authority to make changes to the MassHealth program, with no legislative oversight.

Amendment #337 (Harmful MassHealth Proposal): Sponsored by Rep. Lyons, requires that MassHealth spending not exceed 30% of the total state budget. This would force massive cuts in MassHealth.

April 19, 2018
On Saturday, April 14th, in what seemed to be a precursor to the Boston Marathon, members of the Immigrant Healthcare Access Coalition (IHAC) steering committee completed their own long distance event – they ran the 2018 Democracy School: Building Health Care Power in Immigrant Communities. This training was part of a coordinated, on-going effort to inform immigrants and the groups that serve them about their health care rights. The training also aimed to dispel the growing fear and mistrust within immigrant communities that is preventing many individuals and families from seeking the health care services they need - when they need them. 

A panoramic look at the 2018 Democracy School in action!

Staff members from Health Care For All (HCFA), Health Law Advocates (HLA), and the Massachusetts Immigrant and Refugee Advocacy Coalition (MIRA) spent six months meeting one-on-one with individuals and organizations in the Greater Boston area to discuss the challenges to health care access that are facing immigrant communities and to anticipate  additional challenges coming in the near future.

(L-R) Sally Strniste, HCFA’s Chief of Staff, and Maria R. Gonzalez Albuixech smiling for the start of the training!

Robust recruitment efforts led to the participation of more than 65 health care providers, community based organizations, and individual consumers. Having had a goal of 15-20 attendees, the event’s organizers were thrilled that so many committed advocates and volunteers came together to learn about the immigration rules and regulations that are critical to health care access for the communities they serve.  High turnout at the training confirmed that there is a need for clear information and individual outreach within local communities that are made up of or serve large numbers of immigrants and their families.

By the time April 14th showed up on the calendar, everyone who helped plan the “Democracy School: Building Health Care Power in Immigrant Communities” was eager to implement the training that took place at “La Alianza Hispana” located on Massachusetts Avenue.

(L-R) Suzanne Curry, Hannah Frigand, and Yaquelin Cordon, HCFA staff members and event volunteers, getting ready to receive the participants.

Maria R. González Albuixech, HCFA’s Director of Strategy and Communications, and Deolinda Daveiga, HCFA’s Outreach and IHAP Coordinator, opened the training in English, Spanish, and Portuguese.  Language capacity is a critical piece of the training and the project and all resources were made available in three languages so that attendees could benefit as much as possible from the presentations by following along in the language that was most comfortable for them.

Maria R. González Albuixech and Deolinda Daveiga, both of HCFA, deliver the opening remarks to a packed room

The programming for the rest of the training included a number of presentations from project partners. Liza Ryan, of MIRA, gave a brief overview of changing immigration policy at the federal level. She emphasized the importance of being knowledgeable but also calm during these tense times.

Liza Ryan, of MIRA, delivers the first PowerPoint presentation of the day about federal immigration changes

Following this federal update, Andrew Cohen, the chair of the Immigrant Health Care Access Coalition (IHAC) and an attorney at HLA, focused his presentation on the specific health care protections that immigrants, both documented and undocumented, have under the law. Despite the shifting political landscape, Andrew’s powerful presentation described the changes that are on the horizon and laws that will remain intact in the immediate future.

April 12, 2018

Last week Health Care For All (HCFA) celebrated a tremendous victory along with the many organizations that make up the Protecting Access to Confidential Healthcare (PATCH) Alliance when Governor Baker signed into law the PATCH Act, which advances patient confidentiality protections.

Alyssa Vangeli, HCFA’s Associate Director of Policy and Government Relations, has been leading the PATCH Alliance since its inception close to four years ago. The PATCH Alliance, a group composed of 40+ provider, advocacy and community based organizations, organized support for the bill along with the Massachusetts Association of Health Plans and Blue Cross Blue Shield of Massachusetts.

Alyssa Vangeli, left, and Amy Rosenthal, HCFA's Executive Director, right, wait for the PATCH Act signing ceremony to begin. 

The PATCH Act (An Act To Protect Access to Confidential Healthcare, S. 2296) ensures that when multiple people are on the same insurance plan, confidential health care information is not shared with anyone other than the patient. Health plans typically send a Summary of Payments (SOP) form detailing the type and cost of medical services received to the primary policyholder each time an enrollee on the plan accesses care. The SOP form is meant to explain how and when an insurance plan is being used and is not a medical bill. In some instances, the SOP form may contain information on sensitive health care services and can unintentionally compromise patient confidentiality for anyone enrolled as a dependent on another person’s health insurance policy, such as a young adult or spouse.

The PATCH Act closes this privacy loophole and  gives patients the option to receive SOP forms directly or online after receiving sensitive heath services, rather than have these SOP forms go to the health plan policyholder. The bill also allows patients to opt-out of receiving SOPs if no payment is due. By ensuring that sensitive health care information remains confidential, patients will not have to risk delaying or forgoing needed care, or in extreme cases, risk being traumatized, stigmatized or harmed for accessing services, out of fear that their confidential health care information will be shared.

The PATCH Act waiting to be signed by Governor Baker before the start of the event.

A number of PATCH Alliance member organizations were given the opportunity to stand with Governor Baker for the ceremonial signing of this critical bill on April 2, 2018.

Governor Baker signs the PATCH Act into law.

Alyssa was then given the opportunity to say a few words and thanked the lead sponsors of the bill, Representative Hogan and Senator Spilka, for their incredible leadership and perseverance to make this bill a reality. She also spoke to the strength of the diversity and breadth of PATCH Alliance members, which include provider and advocacy organizations focused on care related to domestic violence, sexual assault, mental health, substance use disorders, sexual and reproductive health, HIV/AIDS and LGBTQ health, among other potentially sensitive services. 

Alyssa Vangeli, HCFA's Associate Director of Policy and Government Relations, speaks during the signing ceremony.

The signing ceremony capped years of hard work and careful negotiations among legislators and interested groups. Most of the provisions of the bill will take effect later this summer, with one delayed until next year. HCFA will closely monitor the implementation of the law to make sure that its provisions are being applied by all insurers.

Passage of the PATCH Act demonstrates the power of HCFA and our partners to effect change by listening to people raising on-the-ground problems, building broad coalitions, and working through the political process.

Members of the PATCH Alliance take a final photo with Governor Baker at the conclusion of the signing ceremony.


-Davis Jackson and Alyssa Vangeli

February 28, 2018

Starting tomorrow, MassHealth is enrolling most members into new health plan options, including Accountable Care Organizations. The change will impact up to 1.2 million MassHealth members.

What are MassHealth Accountable Care Organizations (ACOs)?

ACOs are provider-led organizations that coordinate care and are accountable for the quality and total cost of care of its members. Primary Care Providers (PCPs) work together with members and their team of network providers to coordinate care and connect members with available services and supports. MassHealth ACOs are a new kind of managed care option.

Who is eligible to enroll in an ACO?

People who are required to enroll in some kind of MassHealth managed care plan are eligible to enroll in an ACO. This only affects people who have MassHealth as their only health insurance coverage.

Who is not eligible to enroll in an ACO?

  • People who are enrolled in MassHealth and other health insurance coverage (for example Medicare or employer-sponsored health insurance).
  • People who are eligible for or enrolled in One Care, Senior Care Options (SCO), or PACE.
  • Seniors who are eligible for MassHealth based on their age.
  • People who are only eligible for or enrolled in MassHealth Limited.

Will an ACO be my only option for coverage through MassHealth?

In most areas of Massachusetts, MassHealth members required to enroll in managed care will have the following health plan options:

  • One or more ACO
  • Two Managed Care Organizations (MCOs) – Tufts Health Together and BMC HealthNet
  • Primary Care Clinician (PCC) Plan with the Massachusetts Behavioral Health Partnership

When do new plan options go into effect?

New MassHealth plan options, including ACOs, go into effect March 1, 2018. If you received a green-stripe letter, these new options apply to you. You may have already been assigned to a new ACO.

Can I keep all my current doctors?

MassHealth assigned members to plans that their primary care provider (PCP) participates in. You should check your doctors and/or your health plan to make sure your other providers, including specialists, are included in the new plan’s network. If they are not, you can work with you provider and plan to see if they can join the network, or you may consider switching plans.

What happens to prior authorizations or upcoming medical care?

Even if your current providers are not in your new plan or your new plan has not authorized your services, you will be able to keep scheduled appointments with your current providers and use previously authorized services through at least May 31st. You should work with you plan and providers to figure out your options after March 31st.

Will I be able to switch my ACO or health plan?

MassHealth members have until June 30, 2018 to switch plans. After that, MassHealth members can only switch plans for certain reasons, until March 1, 2019. People who become eligible for MassHealth after March 1, 2018 will have 90 days from the start of their MassHealth coverage to switch plans.

Where can I get more information about my enrollment options?

-Suzanne Curry