Senior home care advocates push back against Statehouse bill

State House News Service
Published: 11/7/2017 11:03:30 AM

BOSTON — Advocates for seniors and people with disabilities are urging senators to re-think a provision of the health care bill teed up for debate this week, citing a national “chorus of antipathy” against similar moves and arguing it won’t produce desired cost savings.

The Massachusetts Law Reform Institute, Mass. Home Care, Massachusetts Council for Adult Foster Care, Home Care Aide Council and Massachusetts Adult Day Services last week wrote a letter to key senators asking them to “respect and honor the right of the elderly and individuals with disabilities to choose the health care plans that they prefer, by ‘opting into’ those plans, rather than by being automatically enrolled in one.”

The groups take issue with three sections of the Senate bill dealing with automatic, or passive, enrollment of seniors into managed care programs. When the senators take up the bill on today, Nov. 8, some of the 161 changes they’ll be asked to consider will include amendments to those sections.

One section “automatically disenrolls thousands of dual eligible seniors” from the state home care program into managed care, according to the letter to Senate President Stanley Rosenberg, Senate Ways and Means Chair Karen Spilka, Senate Health Care Financing Committee Chair James Welch and Majority Leader Harriette Chandler. The groups argue such a move “could sever existing physician and home care management relationships, and is unlikely to save the state any money.”

“Seniors and individuals with disabilities do not want to be viewed as ‘passive’ agents in their own health care future. There has been a chorus of antipathy expressed regarding passive enrollment across the country,” the groups wrote, saying voluntary enrollment and outreach materials that inform consumers of their options are a better route.

Spilka, Welch and Chandler served on the working group that wrote the health care bill (S 2190), which the Senate plans to take up Wednesday and Thursday.

Along with new oversight for pharmaceutical companies, a target for reducing hospital readmissions and other measures, the bill proposes moving MassHealth-eligible consumers participating in the home care program into the Senior Care Options (SCO) program, a voluntary managed care program that covers services normally paid for through Medicare and MassHealth, with no copays.

The senators wrote in a report accompanying their bill that the shift from home care to Senior Care Options would move eligible consumers “from an entirely state-funded program that has separate funding and coordination for home care services, to a federally-matched program that integrates funding and care coordination for all aspects of care.”

Supporters of the home care program dispute the characterization of it as fully state funded and disagree with the idea that moving home care clients into Senior Care Options instead will generate savings.

Al Norman, executive director of Mass. Home Care, said the home care program attracts federal matching funds and is “more cost-effective for the taxpayer.”

The home care program in Massachusetts operates as a continuum with different levels of services, said Peter Tiernan, who formerly served as chief financial officer for the Executive Office of Elder Affairs and is now principal of HCBS Solutions, a consulting firm focused on home and community services. At the level reserved for frail elders, the state receives 50 cents back from the federal government for every dollar it spends, Tiernan said.

Tiernan said the state could also benefit from taking a fresh look at the senior care options program before trying to increase its rolls.

“It’s simply been 10 years since it was launched, more than 10 years, and it’s just kind of time to go back and see if there’s anything that can be tightened up in terms of the rate structure and the enrollment procedure,” he said. “If you do that first, it will ultimately serve the commonwealth better before engaging in passive enrollment.”

The bill’s approach to home care and Senior Care Options enrollment is not set in stone, with some of the 161 filed amendments to the bill proposing changes.

An amendment offered by Senate Minority Leader Bruce Tarr would change language dealing with Senior Care Options from calling for “passive enrollment” to “voluntary enrollment.”

Tarr and Sen. Barbara L’Italien both offered amendments that would strike the section of the bill that calls for enrolling MassHealth-eligible home care clients into the Senior Care Options program and transferring funds from home care to MassHealth.

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