Baker’s reform proposals would make big change to MassHealth

Jule Pattison-Gordon | 7/13/2017, 6 a.m.

In the switch to ConnectorCare programs, the affected individuals would lose coverage for some services such as dental care. They also would experience higher out-of-pocket costs such as co-pays and deductibles, and may have to start paying premiums, said Health Care For All’s Rosman.

“The worst impact applies to low-income parents,” said Rosman. “For these low-income families, having to pay out of pocket will really hurt their ability to get the health care they need.”

According to the state, this transition would allow for maximum use of federal subsidies, and reduce instances of individuals cycling between MassHealth and ConnectorCare as their income fluctuates.

Another suggested measure shifts about 230,000 parents and caretakers with incomes less than 100 percent of the federal poverty level from the standard MassHealth program to CarePlus. According to Rosman, the problem is that the latter program is intended for childless adults and has fewer benefits.

There also is the risk that individuals may be switched into programs that will cease to exist. Should the Congress eliminate or repeal the Affordable Care Act, ConnectorCare and CarePlus could be eliminated, Rosman said. That could throw these customers’ coverage into uncertainty.

Other measures would deny MassHealth eligiblity to low-income adults who have the option of an employer-sponsored plan. Lepore noted that since 2011, commercial coverage enrollee counts have declined, while MassHealth enrollment numbers have grown.

Optional benefits

Bill Henning, co-chair of Disability Advocates Advancing Our Healthcare Right at the Boston Center for Independent Living, and Rosman separately told the Banner that they are concerned over a proposal allowing the state to remove certain optional benefits from MassHealth coverage.

In MassHealth, the state has elected to include certain benefits beyond the basic Medicaid program requirements, such as dental care, prescription drugs, and personal care services for people with disabilities. Henning said that maintaining such benefits is essential to many who currently are covered.

“These are categorized as ‘optional’ benefits under Medicaid, but no one would think they were optional for low-income folks, which includes many people with disabilities and seniors,” Henning said. “The benefits package is great at MassHealth and it serves a lot of poor people who may not get like coverage in private insurance.”

Rosman also expressed concern about allowing such changes to be conducted outside of the legislature.

“The pattern in Massachusetts has been to require legislative approval for those changes and we think giving unconditional approval to the state to make those changes could lead to interruptions in care,” Rosman said.

Employers and dental therapists

Some advocates — and, ultimately, the state legislature — found attractive a temporary measure that would increase employer’s participation in health care coverage for a two-year period. During that period, Employer Medical Assistance Contributions, which help subsidize state healthcare for low-income residents, would increase. Additionally, employers would pay extra for each of their non-disabled workers on state-supported healthcare, i.e. MassHealth or ConnectorCare, during those two years. The latter is not a new idea and it earned praise from some advocates. Both of the temporary employer assessment increases were passed by legislators.

Rosman also spoke in support of a proposal, later rejected by the legislature, that would have created a health care provider class for so-called dental therapists — that is, dental health practitioners who are of a lower level than a traditional dentists and may be more willing to accept MassHealth. Rosman said this measure could bring dental care access to many low-income people.

More deliberation

Speaking last Thursday, Rosman, Henning and Matt Selig, executive director of the Health Care Law Advocates, said they respected the financial pressures behind the proposals but hoped for thorough discussion of possibilities before such a significant changes be approved.

“We [HLA] are hoping that this proposal is a starting point and we’re ready to work with the administration and the legislature and other advocates and business groups and providers and carriers and consumers who we represent… to try to find an alignment of the programs going forward that we think is satisfactory to everybody,” Selig said.