NO ONE ever said that keeping tabs on the 175,000 people getting subsidized coverage under the new state healthcare law would be easy. Not only do administrators have to collect premiums, but they also have to make sure the coverage is not going to people who have other access to insurance as college students, at work, or through other programs. Inevitably, there will be snafus - like the recent failure, reported in Tuesday's Globe, of plan administrators to provide timely notice for appeals to people losing or being denied coverage.
The glitch does point up the need for the state to continue to fund the work of nonprofit community outreach groups that were instrumental in enrolling the uninsured. These 45 groups, many rooted in Spanish- or Portuguese-speaking communities, are still needed to help enrollees in the subsidized program, called Commonwealth Care, navigate the ins and outs of keeping, or losing, coverage.
Both the Patrick administration budget and the House budget would give these groups $3.5 million, half of which would be reimbursed by the federal government. The Senate budget includes no funding. If the state is serious about making its plan for nearly universal coverage work, the conference committee budget should include the $3.5 million.
An official at MassHealth, which runs Medicaid and also administers Commonwealth Care, said there will be reimbursement for enrollees who were forced to pay for expenses for which they should have been eligible for coverage. The challenge will be to ensure that enrollees know how to get this reimbursement from MassHealth. "The state should be very proactive to make sure people don't fall through the cracks on this," said Barbara Anthony, executive director of Health Law Advocates, a Boston advocacy group.
A spokesman for Commonwealth Care said steps would also be taken to ensure that nobody who temporarily lost coverage because of the delayed notice will face the penalty that the state levies on those who lack insurance.
Commonwealth Care is an insurer of last resort for people who earn too much to be eligible for Medicaid but too little to afford unsubsidized coverage, and get no insurance through their employers or other programs. To keep costs under control, it is crucial that the state make sure that enrollees meet these standards. At the same time, consumers trying to get this coverage are going to need help if they are denied it wrongfully or so belatedly they have no time to appeal. The $3.5 million for community outreach groups will be money well spent.
