Here’s some tips for navigating MassHealth changes

Recorder Staff
Tuesday, April 24, 2018

GREENFIELD — About 1.2 million of the 1.8 million MassHealth consumers are having their health coverage changed to some degree, leaving local providers and advocates scratching their heads on how to best serve their clients.

The changes are a result of alterations to the state’s formal model of care, creating what are known as accountable care organizations (ACOs). From March through May, there are a handful of pieces in motion before they get locked in on June 1.

The nonpartisan statewide Health Care for All advocacy group provided some guidance on how people can navigate the changes.

The people who are likely affected are those on MassHealth, more generally known as Medicaid. They are under the age of 65, so they are not on Medicare, and they are not disabled or do not have a secondary form of insurance.

Suzanne Curry, the group’s associate director for policy and government relations, outlined the three first-options someone can take.

People can call MassHealth to ask about how their enrollment might have changed; they can go to a local community health center or hospital and ask for assistance there or they can work directly with the health plan they’ve been assigned or the one they may want.

The most common question people have, Curry said, is not just what insurance plan they may be on and what that means, but first, what is an ACO. She explained it as a plan for better coordinated care to lead to better health outcomes. This means different health care groups, from hospitals to insurance providers, from mental health services to those for elders, will, in theory, be in more coordination with each other.

Curry recommends that people think about what is the most important part of their current health care service, between their primary care and their specialists. The reason to look at it through this lens is in case those two groups are no longer in network with each other, an individual can still have access to the doctor who plays the most important role and then arrange the plan around the coverage network.

In the 90 days of this transition to new coverage plans, some health care providers are essentially waiving any gaps in that period, while all are obligated to continue coverage for the first 90 days. This “continuity of care” piece of this has been one of the most confusing and controversial elements of this government rollout.

“It is confusing, but there are resources out there,” Curry said. “We just want to make sure people know there is something happening so that they can figure out something is going on.”