State eliminates deductible for free-care patients
Small copayments remain for hospital visits, medicines
After facing a barrage of criticism, the state backed off plans yesterday to require low-income patients to pay the equivalent of a small insurance premium before they get free care at hospitals.
But in a compromise plan intended to reduce dependence on the state's free-care pool, care will no longer be completely free for the lowest-income patients.
Starting Dec. 1, the rules will require small copayments of $1 or $3 on prescriptions for all eligible patients. Those with an income between 101 percent and 200 percent of the poverty level will face copayments of $5 for a hospital office visit, $50 for an inpatient hospital stay, and $50 for an emergency room visit that does not result in an admission. Those fees will be capped at $250 a year.
There are no copayments for children or for care at community health centers.
The rule changes to the free-care pool are an important part of the state's landmark initiative to get all Massachusetts residents covered by health insurance. To provide state-subsidized insurance, the state is using money that was previously spent on the free-care pool.
But engineering the transition is proving to be a delicate job.
The final revisions eliminate a $35-a-month deductible state officials had proposed earlier for some free-care patients. Those deductible payments, which state officials sought as an incentive to encourage people to move off free care, drew the greatest fire from healthcare advocates and hospitals that serve large numbers of low-income people. They said the deductibles would scare some needy patients away and would be difficult for hospitals and healthcare centers to collect.
Last night advocates and hospital officials praised the compromise rules, which were revised from a draft issued in July, but said some problems remain.
"This is a more durable safety net for folks who will fall between some of the cracks of the health reform law," said John McDonough, executive director of the advocacy group Health Care for All. "The administration listened very carefully to the concerns raised . . . and the final regulations address the most serious concerns."
As part of the plan to reduce dependency on the free-care pool, the state will no longer reimburse hospitals and community health centers for care they provide for patients who would otherwise be eligible for insurance through the state Medicaid program or state-subsidized Commonwealth Care.
Hospitals and community health centers had suggested that restrictions on eligibility for state-paid "free care" would leave their institutions in debt since they would be reluctant to turn needy patients away. That concern remains, despite some easing of the eligibility criteria.
The final eligibility rule gives a reprieve to people with access to affordable coverage from their employer who haven't purchased it. They will still be able to get state-paid free care until April 1.
"There are still hundreds of thousands of uninsured people who need to enroll [in state insurance programs] and haven't yet," said Ellen Murphy Meehan, spokeswoman for a group of urban hospitals called the Alliance of Massachusetts Safety Net Hospitals. "Ultimately, there's no way you can deny payment to hospitals and health centers in the poorest cities in the state and expect they are going to be able to sustain their services."
State officials have said they would carefully monitor the changes in free care and make further adjustments if necessary.
"These regulations represent an important step in healthcare reform implementation and demonstrate the state's commitment to aligning incentives to get as many people as possible enrolled in affordable health insurance plans," Sarah Iselin, state commissioner of healthcare finance and policy, said in a prepared statement. 