The removal of nearly 30,000 legal immigrants from subsidized health coverage under Commonwealth Care may increase the amount Massachusetts taxpayers spend to cover the remaining low-income residents enrolled in the program, state officials said Thursday.
Four health plans offered through Commonwealth Care – BMC HealthNet, Fallon Community Health Plan, Neighborhood Health Plan and Network Health – and sanctioned by the state to provide partially or fully subsidized coverage to more than 150,000 low-income residents will need to submit bids to renew their contracts by early next year. Because the legal immigrant population tends to be healthier and cost less to cover than the general population, officials of the state Connector Authority said, their removal could drive up how much the state spends to cover other members of those plans.
This potential increase in subscriber “acuity” would likely be reflected in bids the Connector receives in March 2010, they said.
The four plans in question insure the bulk of residents enrolled through Commonwealth Care, the hallmark program established in the state’s 2006 health insurance access law. A fifth Commonwealth Care plan, CeltiCare, a new entrant in the Massachusetts insurance marketplace, has contracted with the state to provide limited coverage to the affected immigrant population through June 2010.
During an authority board meeting, officials did not offer details to specify cost impacts or explain immigrant health cost factors. Data on the effects of the immigrants’ disenrollment is not yet available, staff said, noting that a more detailed picture would be presented at the December meeting of the board.
“It is a rather complicated analysis and we want to make sure to get it right,” said Patrick Holland, the Connector Authority’s Chief Financial Officer, who noted there are still questions about the health of the general population that must be answered as well.
Connector Executive Director Jon Kingsdale emphasized that the assumption that the immigrants’ removal would lead to an increase in acuity is “a reasonable belief” but not a certainty.
“We don’t have the data yet,” he said. “Nobody here is saying that acuity went up.”
Terry Dougherty, who heads the state’s Medicaid program, known as MassHealth, said theoretical changes in acuity should be measured against the immigrants’ actual health care costs since they were disenrolled from the Commonwealth Care plans. He noted that although the legal immigrants are considered a generally healthy population, there were four or five kidney and bone marrow transplants among them since they switched plans.
More than 21,400 of the immigrants have enrolled in the new, lower-cost plan operated by CeltiCare, a new entrant in the Massachusetts insurance market seeking to gain a foothold, Kingsdale said at a board meeting at One Ashburton Place.
“It’s been going very, very well,” he said, “actually, far better than I personally expected to date.”
Although the Patrick administration won applause for helping piece together the CeltiCare coverage, advocates for the immigrants feared that CeltiCare’s narrow network of hospitals and providers could disrupt care. The Boston Globe reported last week that many immigrants enrolled in CeltiCare have been informed that their current health care providers are no longer able to provide care because they are not included in CeltiCare’s network.
The immigrants were initially removed from coverage in June, when the Legislature slashed their eligibility for state subsidized care, a move aimed at saving $130 million and helping balance the fiscal 2010 budget. Gov. Deval Patrick sought to restore partial coverage at a cost of $70 million, a total the Legislature reduced to $40 million during further deliberations. The cuts enraged advocates for immigrants and universal health care, and forced the Patrick administration to cobble together a coverage option with less than a third of the originally estimated funding. Patrick will file his fiscal 2011 budget in early January, and it is unclear whether the immigrants will be merged back into Commonwealth Care.
The immigrants faced with disenrollment are known as “aliens with special status” (AWSS), legal residents who have been in the United States for less than five years. Those immigrants are not eligible for federal Medicaid benefits, which means the state picks up the entire tab for their care.
CeltiCare worked closely with state health and human services officials to develop a plan that covered basic services like preventive doctor visits and prescription drug care, but the plan also comes with higher co-pays for emergency room visits and other services than plans offered by the Connector. It also lacks coverage for dental, vision and skilled nursing services.
The CeltiCare plan, which took effect on Oct. 1, a month after the immigrants were cut from coverage, at first enrolled only Boston-area immigrants. On Nov. 1, that coverage expanded to include North Shore and Central Massachusetts residents, and the remainder are scheduled to be eligible on Dec. 1.
“The administration’s focus through the whole AWSS discussion was to try to keep them on CommCare and not treat them separately,” said Jay Gonzalez, secretary of administration and finance and chair of the Connector board. “Our focus since that point, and once we knew what we had to work with, was to try to do what we could to maintain comprehensive coverage for that entire community ... this solution is one that appears to be working, and almost miraculously, we’re at the point now where almost all of these legal immigrants are going to be covered.”
Officials with the Massachusetts Association of Health Plans, who previously expressed concerns with the selection of CeltiCare to cover the immigrant population, were not immediately available for comment.
At the board meeting, members voted unanimously to approve regulations sanctioning the changes in immigrant enrollment, changes that were approved on an emergency basis at a previous meeting.
The approval came over the objection of Health Law Advocates, which argued that the Connector shouldn’t sanction the removal of a single group from coverage, and despite a request for an amendment from the ACT!! Coalition, which Connector staff said would have been less precise.
