No confusion - state health insurance sign-up is now
The annual open enrollment period for Commonwealth Care, the subsidized state health insurance plan enacted to provide universal access to insurance coverage for all Massachusetts citizens, began on May 25 and extends through June 25.
Island members of Commonwealth Care have the opportunity to choose between one of the two nonprofit managed care organizations the state's Health Connector, the agency that administers the state insurance plan, has approved to provide Island coverage.
Boston Medical Center (BMC) Health Net, the first plan made available to Islanders following the implementation of the state's landmark law in 2006, is not one of those plans.
By law, with some exceptions, all residents of Massachusetts must have health coverage that meets state standards. Commonwealth Care premiums are based on income, family size, and plan coverage. There are currently more than 1,200 residents enrolled in the plan.
For all practical purposes, Islanders who subscribe to Commonwealth Care must choose an insurer that has a contract with the Martha's Vineyard Hospital, the chief provider of health-care services on the Island. There are two choices in the current enrollment period.
Network Health Plan, a managed care organization started by the Cambridge Health Alliance, has offered coverage to Islanders for more than one year. It will continue to do so and has a contract with the hospital.
Neighborhood Health Plan, founded by the Massachusetts League of Community Health Centers and the Greater Boston Forum for Health Action, recently extended its coverage area to the Island. The insurer has signed a contract with the hospital that is effective July 1.
But not BMC Net
BMC's contract with the Martha's Vineyard Hospital expires at the end of this month.
Boston Medical Center Hospital, formerly Boston City Hospital, founded BMC Net in 1997, to offer health care coverage for MassHealth (Medicaid), which provides health care for certain low-income residents, and Commonwealth Care participants.
Tim Walsh, the Martha's Vineyard Hospital CEO, said the hospital decided to end its contract with BMC after the relationship became problematic. In a telephone call Tuesday, Mr. Walsh outlined the reasons for the hospital decision.
Primarily, he said, it was the difficulty Vineyard hospital doctors encountered attempting to place patients in hospitals other than Boston Medical Center Hospital, for instance Children's Hospital Boston and Mass General Hospital.
"When we signed the original contract, we had talked about referrals and the fact that our natural referral pattern is to Mass General, primarily," Mr. Walsh said. "And they assured us they would not interfere with the natural referral processes that are here. It turned out not to be true, because we had a lot of trouble placing people anywhere but BMC."
Mr. Walsh said the administrative burdens BMC imposed were also too much for Martha's Vineyard Hospital to handle effectively, and as a result, some accounts went unpaid.
Mr. Walsh had said the decision to drop BMC Net would not affect the ability of Islanders currently enrolled to access a new plan.
Gazette coverage misleads
Mr. Walsh was sharply critical of recent coverage of the transition in the Vineyard Gazette. He said a story published on April 10, "Hospital to drop insurance contract; many low-income Islanders affected," and another on May 29, "Hospital decision leaves 1,500 Islanders uninsured, confused," caused people to think that hundreds of Islanders would suddenly be left scrambling for insurance. He said that the newspaper reports unnecessarily alarmed people now in the plan. It is simply untrue, he said, to say that people would be left uninsured.
"Open enrollment, changing a health plan from one to the other, is not that onerous," said Mr. Walsh. "To the extent people might have been confused, they might have read the Gazette story, which did not explain to people what the Health Connector is, how it works, or provide contact information. People can just call there and make the switch over the phone."
This month Commonwealth Connector will send an information packet that describes the open enrollment period, and they will conduct a "multi-prong effort" to inform residents of the changes, according to state officials.
The county's Health Care Access Program, which holds a state contract to provide outreach and enrollment for affordable insurance plans in Massachusetts, including Commonwealth Care, will also be conducting a series of Monday workshops over the next three weeks, Sarah Kuh, the program's director, said this week.
In a telephone conversation late Tuesday, Ms. Kuh said the office had assisted 53 people in the first week of open enrollment that began on May 25.
On an average Ms. Kuh said her office has enrolled about 800 people per year in Commonwealth Care. She said there are likely several hundred more individuals who enroll on their own or through the hospital.
Ms. Kuh said that while the departure of BMC will leave the Island without an HMO that provides MassHealth as opposed to Commonwealth Care, there would be no loss of coverage for lower income adults and children, the primary user group, since they would be covered by a non-HMO state program.
She said it is not true to say that 1,500 people, the total number of BMC Commonwealth Care and MassHealth subscribers, will lose insurance, as has been reported.
"It is quick and easy to change plans," Ms. Kuh said. "And if people don't change plans through one of the means available to them, then they will automatically be assigned to a plan." A Commonwealth Care subscriber could do nothing and be reassigned to either the Neighborhood Health or Network Health plan.
A new choice
With the departure of BMC Net, Network Health is stepping up its efforts. In a recent telephone conversation, Deborah Gordon, senior director of marketing at Network Health, described some of the benefits the company will provide for Vineyard residents who are a part of the Commonwealth Care program. In addition to Martha's Vineyard Hospital, Network Health has contracts that include Jordan Hospital, Falmouth Hospital and Cape Cod Hospital.
Ms. Gordon said the company has been serving people in the Medicaid program since 1997, and in 2006 launched its Commonwealth Care plan, "Network Health Forward," in response to changes in Massachusetts law.
Asked what consumers ought to consider when deciding on a plan, Ms. Gordon said access to doctors and the monthly premium balanced with a plan's benefits are important factors.
Ms. Gordon said Network Health has had a longstanding relationship with Partners HealthCare system, of which Martha's Vineyard is a part, and its member hospitals, including Mass General and Brigham and Women's in Boston. "We have a robust network of over 60 hospitals across the state and 15,000 providers total," she said.
Network Health offers members a 24-hour nurse hotline, a reimbursement program, and discounts intended to promote good health and fitness practices. "We are a mission-driven nonprofit organization, and our purpose is to improve the health and well-being of our members and their communities," said Ms. Gordon. "For us, the investment in people's health is core and critical to our mission."
Asked how state budget pressures could affect her organization, Ms. Gordon said that Network Health is well aware of the economic situation across the state and the country. "What we do is we run extremely lean," she said. "So most of the money we bring, the vast majority, covers the cost of our members' medical care. Administrative overhead is extremely thin."
For more information on Commonwealth Care, call the Martha's Vineyard Hospital financial counseling office, at 508-693-0410, ext. 248; Vineyard Health Care Access Program at 508-696-0020; or go to:mahealthconnector.org; network-health.org; or www.nhp.org.
