Keep reaching out to uninsured

WITH BOTH the economy and the state's revenues plummeting, no one envies Governor Patrick the task of cutting a budget that was approved by the Legislature just a few months ago. But one item the governor should spare is the $3.5 million outreach program to enroll - and keep enrolled - the uninsured in the state's pioneering universal healthcare plan.

One reason the state has achieved the highest rate of insured residents in the nation - 94.6 percent - is that knowledgeable workers with needed language skills from 45 community organizations have helped mostly low-income residents to navigate the ins and outs of Medicaid, the subsidized Commonwealth Care program, and the unsubsidized Commonwealth Choice plans. The "outs" are as important as the "ins" because enrollees can get unceremoniously thrown out of the publicly supported programs if they change jobs or get raises.

The dreaded bureaucratic term for this is "redetermination." According to a Globe report, between Jan. 1 and August, tens of thousands of newly insured residents in the state plan had their coverage terminated, for legitimate reasons or through mistakes of their own or the state's. But when patients' coverage is terminated and, through snafus of one kind or another, they are not immediately informed, they run the risk of incurring heavy medical bills without reimbursement.

One source of the complexity is that while many of the uninsured sign up with the state's Connector Authority for Commonwealth Care, they deal with a different state agency, MassHealth, to prove they are eligible.

Unlike workers who are insured through their employer and can turn to their human-resources office for assistance in insurance wrangles, the newly insured in the state programs don't have that option. They need the support of the community workers, who also often steer them to providers and help set up initial appointments.

In just the five months between December 2007 and April, outreach workers had contacts with more than 93,000 people and enrolled 39,189 in state programs. Without these workers, the Massachusetts plan could remain a national model in design but hollow in practice.

A spokeswoman for the state Department of Health and Human Services would not confirm that the outreach program is a candidate for the chopping block, saying only that the department "can't rule anything out." But it should rule out the elimination of any budget item, like the outreach program, that is so central to connecting the uninsured with state coverage plans - and keeping them connected.