Tomorrow approximately 11,500 people in the Boston area will become enrolled in the new Commonwealth Care Bridge program – nearly a third of the 31,000 people who are categorized as special status immigrants and who, because of budget shortfalls, lost their access to health care coverage on September 1. We at Health Care For All have heard from many of these people and they are worried about what will become of their care tomorrow. They have spent the last month without health care coverage, and have been anxiously awaiting the details of this new program.
Health Care For All joined with advocates from all over Massachusetts who pushed to have adequate funding included in the state’s woeful budget to cover this group of legal, taxpaying state residents, who previously received care through Commonwealth Care. Our best efforts resulted in the legislature passing a $40 million appropriation, which is less than a third of what the state spent on coverage last year. So, the Bridge program begins as being severely underfunded.
The winning bid for the Bridge program was awarded to a for-profit insurer called CeltiCare. CeltiCare’s proposal included a benefit package that most closely mirrored, but was not identical to, the comprehensive benefits in Comm Care, and the proposal included some underwriting by CeltiCare’s parent company Centene that would supplement the $40 million of state money to cover the 31,000 people.
This is not ideal. We are worried about the breadth of the network available and the capacity for culturally appropriate care for this group. Most of the 31,000 people who are being moved into this new coverage program face the threat of being disconnected from their current health care providers. Today’s Globe covered this issue of the limited network being put in place by CeltiCare. Beth Israel Deaconess CEO Paul Levy writes eloquently today in his blog (“Immigrants left in the lurch again”) about the importance of providing care that meets the language and other specialized care needs of immigrants, and his fears that this will be lost as the CeltiCare network excludes his hospital along with Boston Medical Center and Cambridge Health Alliance.
I have been encouraged by what I have heard from the leadership of CeltiCare. We have repeatedly asked about the people who are in active treatment – meaning that they are in the midst of care for an ongoing issue like cancer, and have been assured that those individuals will be allowed to continue their care with their current provider team. (See the previous post for info and phone numbers about how to pursue individual cases, or call the HCFA Helpline with any concerns.)
What happens tomorrow, and then will be repeated on November 1st and finally on December 1st will be messy, and not perfect. Health Care For All’s primary concern is for the quality and continuity of care that the 31,000 individuals receive in the Bridge program. We will be monitoring this process closely and will be sure to raise alarm bells if they are needed. For-profit insurers are receiving tons of bad press these days. Here in Massachusetts 31,000 residents are counting on Celti-Care to provide thoughtful, accessible, culturally competent care.
-Amy Slemmer, Executive Director
I would like to point out that due to the religious mission of the Caritas Healthcare System, family planning with real options will not be available to patients being forced onto this new plan and therefore forced to receive their care from Caritas. I would also like to point out that the logistical issues and barriers that exist for many of these patients to quite simply get to their appointments does pose the very real issue that for many of these patients, getting to their new healthcare providers will be extremely time consuming and expensive if not impossible. Thus, Paul Levy wondering about the underlying motive of this FOR profit HMO’s move it quite relevant. The reality for many of these patients is that they will continue to go to their known providers for the simlpe reason that the providers are extremely accessible and many members do not understand the ins and the outs of their insurance policies rules, especially when the rules keep changing. It is also important to point out that there is no real choice in this matter for these patients- the only choice is self pay. In this state, it is required by law to have health insurance. And now, these patients are being give 1 option that does not make sense for their lives or meet the full spectrum of their needs. And to go without this one option they are being offered, they would get penalized under the law. Real Health Care Reform NOW! PLEASE. Is this really what Ted Kennedy would have wanted to have happen with healthcare in our state?
For Paul Levy, CEO of Beth Israel Deaconess Medical Center, an experienced and respected healthcare executive to “wonder” about the quality of care that will be authorized by CeltiCare, to “fear” things which have not yet happened, to suggest avaricious and unethical financial motives of a new company of which he has very little knowledge, is quite simply irresponsible. One must wonder what is his agenda? Why does he attempt to besmirch the efforts of a new healthcare management organization? Could it be precisely because his hospital was not given a provider contract with CeltiCare? Why doesn’t he wait to see how CeltiCare actually performs and then base his comments on actual data? His comments seem to me to be a pre-emptive strike against CeltiCare, designed to evoke fear and anxiety in the very population to be served by CeltiCare. At such a crucial time for healthcare, it would be far more appropriate for Paul Levy and any other agenda-driven critics to be welcoming a new organization that is willing to serve this population when quite obviously other organizations in Massachusetts weren’t, and to wait and watch to see how CeltiCare actually conducts its task.
31,000 residents? 31,000 individuals?
Which is it?
If they are special status immigrants, and not naturalized United States citizens, how can they be “individuals” as the United States defines the term?
Amy & Paul:
You both are right. The deal with CeltiCare was far from perfect, and CeltiCare’s implementation of the proposal leaves much to be desired. But the real culprit here was the Mass. Legislature that chose first to write-off this population, and then reluctantly agreed to put only $40 million on the table for coverage that was costing $130 million.
Our efforts need to be redoubled to make sure that the “Bridge” program leads us back to full inclusion of the AWSS population in full Commonwealth Care beginning in July.
Amy,
Well put. But … as to “we have been assured that those individuals will be allowed to continue their care with their current provider team”, there is a disconnect. We and others have been clearly told that people will not be covered in our hospitals. The insurance company has not institutionalized any arrangement to the contrary. Also, what about ongoing care for less serious, but chronic conditions?
I am sorry to say this, but this makes me wonder if the insurance company is just hoping people continue to go to their regular providers, where the insurer won’t have to pay for care. You know that all of us would never turn anybody away. Then, they get to pocket the savings, since they are being paid a lump sum for the entire time period. (Is this some odd variant on global payments: Take the money and have someone else deliver the care — versus being part of a thoughtfully integrated patient management system?)
Paul