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MassHealth changes causing stress, confusion

  • Dr. Ruth Potee Contributed Photo



Recorder Staff
Monday, April 02, 2018

GREENFIELD — Some Massachusetts residents have faced a host issues as a result of a change in MassHealth, which was rolled out March 1.

The changes have left some residents thinking they cannot get their services and some providers believing they cannot help them. Local service providers say the roll-out of Affordable Care Organizations (ACOs) has left things in disarray,

The ACOs are newly formed care providers, combining behavioral health and long-term services. The new groups may not cover the prescriptions or services someone is currently using, at least at the moment.

The lead-up to all of this was a moment of expected “utter chaos,” Dr. Ruth Potee, a local opioid expert said. “I think a lot of us are completely confused.”

Notices about the changes were sent out to MassHealth participants in late 2017 and the special “plan selection period” began March 1. By June 1, the “fixed enrollment period” begins, when people on MassHealth, the state-federal Medicaid program for the poor and disabled, have to figure out the best plan for them.

Through all of this, there is a “continuity of care” provision that says medical services and prescriptions have to be extended for at least 30 days — but this piece has been lost on many among the swirl of new changes that make little sense to even providers in the field.

That’s why at Friday’s regional Opioid Task Force health care solutions meeting, members invited statewide expert Suzanne Curry, associate director of policy and government relations for Health Care for All, to explain what’s happening.

“This is a confusing transition for everyone and this isn’t working as well as we would like to see,” Curry said, who noted on March 1 MassHealth received what she said was a record of 40,000 calls in one day.

While Curry went through a PowerPoint that tried to explain all of the moving pieces, the couple dozen service providers in the room at the John Olver Transit Center in Greenfield peppered her with questions on the many gaps they’ve seen this month.

“How do we find the people who are about to fall through the cracks?” Potee asked.

Curry recommended a public campaign to help educate people on their coverage and choices, despite it already being March 23 and although everything will be finalized in just over two months.

Potee explained the instance of a patient she may have, who has been on medically assisted treatment for years to battle an addiction, but whom she only sees every three months. She wonders what happens to that person who may have had no point of contact to learn what’s going on.

“If you think we’re confused, and we’re running these organizations, how do you think the patients feel?” Potee said.

She and others are worried about people missing integral treatment in this first month of the new care under the ACO rules, but also about what happens when May comes and there is no longer a legal buffer for patients whose insurance no longer covers their treatment.

Regional sober-housing provider Shawn Hayden, of GAAMHA housing, explained this has become particularly cumbersome for people he sees at halfway houses. They already struggle getting adequate access to medically assisted treatment, and when they may relocate to another home in another region of the state, the ACO network, which is set up regionally, may not cover them anymore.
   “We’re not entirely sure what to tell people,” Hayden said.

You can reach Joshua Solomon at:

jsolomon@recorder.com or

413-772-0261, ext. 264