MassHealth dynamics ‘coming to a head’ this year


By Matt Murphy


STATE HOUSE, BOSTON, MARCH 17, 2015….As Gov. Charlie Baker targets MassHealth for major budget savings, a top House lawmaker said Tuesday that policymakers can’t lose sight of the “ideals” of the program, which will cover 1.7 million residents with health insurance next year.

Rep. Jeffrey Sanchez, the co-chair of the Committee on Health Care Financing, spoke to a room packed with aides, lobbyists and lawmakers on hand for a briefing on the MassHealth program.

“Make no mistake about it. MassHealth serves the poorest and those folks that need it the most,” Sanchez said. “It is growing unsustainable, but there is a lot of good that happens out of this program, and we have to stay focused on making sure that we live up to the ideals of what MassHealth is about and the ideals of what we embarked on when we started with Chapter 258 back in the early 2000s which was to insure the population, also to seek the quality and also to bend the cost curve.”

The legislative briefing hosted by Health Care for All and Affordable Care Today featured explanations of the $14.5 billion program as well as testimonials from subscribers.

Senate Majority Leader Harriette Chandler acknowledged that the balance between providing coverage and care and controlling costs at MassHealth were “coming to a head” this year.

“It’s coming to a head as we move forward with the Affordable Care Act, as we in the Legislature are concerned about how you balance quality and access and cost and make it all happen,” Chandler said.

Chandler, a Worcester Democrat and career champion for oral health, plugged her own bills (H 262) to fully restore MassHealth adult dental coverage and another bill on the Senate docket requiring the Executive Office of Health and Human Services to design a pilot program for children on MassHealth to prevent cavities at a young age to save on dental care as they mature into adults.

Baker’s fiscal 2016 budget proposal limits spending growth at MassHealth to 5.6 percent by squeezing $761 million in savings from the program without cutting back on benefits, with the exception of chiropractic services.

Baker has also proposed to fund a full year of adult dental benefits.

The administration hopes to save $210 million next year by going through an eligibility redetermination process for 1.2 million MassHealth subscribers, as required by the federal government.

Health Care for All Executive Director Amy Whitcomb Slemmer said her organization was working with MassHealth to make the redetermination process go “as smooth as possible” and ensure those eligible for benefits don’t “fall through the cracks.”

Slemmer said there has been some confusion among members about who must reapply and how soon they must file their paperwork, and Health Care for All hopes to work with the administration and other groups with direct contact to consumers to improve communication.

Slemmer said Health Care for All was “grateful” that Baker’s budget proposal largely maintained benefits for MassHealth recipients, but said she did have concerns about the administration eyeing possible cost-sharing adjustments in the futures.

Health and Human Services Secretary Marylou Sudders earlier this month said the administration may look at co-payments or other commercial market solutions to control cost growth in the future.

“A number of states have implemented co-pays so we’re going to look at that experience. That might be something we look at for FY ’17,” Sudders said. Co-pays are restricted within Medicaid from being applied to many services, including emergency, mental health and substance abuse, and child services.

“That will have direct impact on people’s pocketbooks and MassHealth members who don’t have a whole lot of margin to work with,” Slemmer said.

Sanchez said he hasn’t set any parameters for looking to wring savings from MassHealth and is in the process of talking with stakeholders to collect ideas.