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Fight grows over shift of seniors’ health plan

By Kay Lazar
Globe Staff / April 28, 2010

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Legislation that could push more than 100,000 low-income senior citizens in Massachusetts into managed care health plans spurred intense lobbying yesterday, as consumer advocates argued the measure would strip patients of their freedom to stay in traditional Medicare, while proponents said it could save the state significant money.

At issue is a bill sponsored by Representative Peter J. Koutoujian, a Waltham Democrat, which would require elders who are receiving both state-subsidized Medicaid health benefits and federal Medicare coverage to be automatically enrolled in managed care health plans. Known as Senior Care Options, or SCOs, the plans are paid a fixed monthly amount to provide all of a person’s care.

Elders would be automatically enrolled unless they chose another plan first, and they would be required to stay in the managed care plan they were assigned to for at least three months before opting out.

A legislative committee yesterday delayed action on the bill for several weeks to give lawmakers more time to study the highly charged issue.

“This amounts to a ‘caste’ system in which poor people lose the health care choices that middle and upper income people would never relinquish to the government,’’ said Al Norman, executive director of Mass Home Care, an association of nonprofit agencies against the bill.

The Massachusetts AARP, the lobbying group for older Americans, also opposes the proposal, saying in a statement that it “does not provide the greatest amount of consumer protection.’’

Paulette Song, a Patrick administration spokeswoman, said administration officials had not read the Koutoujian bill and could not comment.

Koutoujian said in an interview yesterday that he “respects the concerns’’ of consumer advocates, but that all of the information he has read about the programs indicates they “reduced costs, increased patient [beneficial] outcomes and increased patient satisfaction.’’

The programs were launched about a decade ago by the state, but relatively few elders have opted for such insurance coverage. Today, there are about 14,000 seniors enrolled in four plans statewide, out of roughly 130,000 who are receiving both Medicaid and Medicare.

John Baackes, chief executive of Senior Whole Health, a for-profit, Cambridge-based Senior Care Option, said his company is saving the state about $40,000 a year for each elder that his company arranges care for in the community instead of in a nursing home. He said his company has managed to keep roughly 2,330 patients who would otherwise be in a nursing home in the community.

Baackes pointed to a report commissioned by the state that concluded last year that such Senior Care Options can reduce nursing home use by as much as 50 percent. But critics of the report said it was flawed because it did not study enough cases to draw accurate conclusions.

Dr. Robert Master, a primary care physician who is chief executive of Commonwealth Care Alliance, a Boston-based nonprofit Senior Care Option, said even though his managed care company and others have the potential to save the state significant money, he opposes enrolling elders in the plans without consent.

Master said that could end up being more costly for the state because the companies labor to craft a plan for elders when they are first enrolled, and if they back out after three months, the funds would be wasted.

Representative Harriett Stanley of the legislature’s Joint Committee on Health Care Financing filed an amendment to the proposed House budget for the 2011 fiscal year that would require the Executive Office of Elder Affairs to negotiate a waiver from Medicare and Medicaid rules with the federal government to allow the state to proceed with such a program. House members approved that amendment last night.

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