Urgent: MassHealth members, check plan assignments

[siderea]

[X-posted to both b0st0n and davis_square]

tl;dr: If you have MassHealth, you may have been assigned to the CeltiCare plan without knowing it. Many people think this is a bad thing. You have until this Friday, Jan 31, to call MassHealth and change it. Otherwise, you're stuck with it until the next open enrollment period, no idea when that will be.

More info:

Today, my clinic learned that MassHealth had notified all members that plain-old MassHealth is going away, there is a new thing called MassHealth Careplus they were now in, in which they had to choose plans, and if members didn't choose plans by a certain date (Jan 1?), they were defaulted to CeltiCare. Expect apparently a lot of people didn't get the notification? Or didn't understand they had to do something? Or didn't realize the consequences?

People are apparently discovering this only after they try to use their insurance. CeltiCare has a very small number of providers, all(?) clustered in Boston, and I gather very demanding prescription pre-auth requirements. My clinic doesn't take it at all, and now all our patients who were defaulted to CeltiCare need to fix this in the next 48hrs or they lose access to their doctors and therapists.

Because the current open enrollment period ends 1/31. After that, you're stuck with whatever plan you're in until the next open enrollment period. No idea when that is.

If you are a MassHealth member, and didn't realize you had to pick a plan, you may have been assigned one -- possibly one that really doesn't work for you.

If you are a MassHealth member, to find out what plan MassHealth has you in, call the main number, the one on the back of your MassHealth card: 800-841-2900. They're open 8am to 5pm, M-F. They will change your plan if you ask them to by Friday.

You may want to call your doctors, pharmacies, therapist, etc and ask which MassHealth plans they take, if you are affected by this change over. Apparently a lot of clinics which previously could be characterized as "take MassHealth" as of the end of the month no longer do -- they take specific plans within MassHealth. This is part of the confusion; members don't realize they have to make sure their providers, whom they've been seeing for years on MassHealth, will take their new MassHealth Careplus plan.

Please also be aware, just because you used your MassHealth coverage to get medical care this month doesn't mean that everything is fine: during this month, because of open enrollment transition, all previous MassHealth providers were (I am told) allowed to bill all plans, regardless of their contractual agreements. That goes away 2/1/2014, and providers can only bill to the plans they're signed up to take. So my clinic has been able to see CeltiCare patients all this month, because they come up on our computer as "sure, the insurance will pay." We didn't realize there was a problem until now.

Comments

[myselftheliar.livejournal.com]

Thank you so much for posting this. I had to fix my own stuff earlier in the month and am LUCKY a medical issue caused me to catch it. My PCP and specialist both do not accept CeltiCare, and had i not been able to switch.... not good. this is something that is NOT being publicized enough!

[prunesnprisms.livejournal.com]

My rough understanding was that Commonwealth Care was going away and turning into CarePlus, as well as some parts of what's been called MassHealth, as part of the the qualified health plan piece of the Affordable Care Act -- tl, dr -- Massachusetts who already had universal coverage had to adapt some things we'd already done to the ACA.

not that this changes your message -- keep trying to get the word out.

[clevernonsense.livejournal.com]

Not that it's that important, but CarePlus is a MassHealth program that's replacing a lot of the smaller MH programs that had been created over the years to serve specific populations (I think low income pregnant women is one group but I'm not sure and don't care to research it; it also includes a lot of people who generally only qualify for MH due to a special circumstance rather than straight up qualifying for MassHealth Standard). MassHealth is a government agency, while Commonwealth Care comes from the RomneyCare pre-ACA Health Connector, which is essentially a gov. funded independent nonprofit.

Because the ACA expanded medicaid, some/many people who were getting coverage through Commonwealth Care may now be eligible for one of the MassHealth programs (which tend to be better and obviously a lot cheaper), which is close to what you were saying I think (most Commonwealth Care members of old will not qualify for MH though). AFAIK, everyone on the various Health Connector plans from pre-ACA need to re-enroll on their own and none were automatically transferred.

MassHealth tried to create a system where most of their clients would be automatically transferred to a new program. In all cases, the new programs are the same price or cheaper and offer more coverage, but obviously as the poster points out there are other issues to consider. Honestly, anyone on any of the MassHealth or Connector plans should be really proactive and look at their current (new) plan or take steps to reenroll. Forcing the states to adopt the website at the same time was probably the biggest mistake/disaster of the ACA.

One other point about the main post: There isn't really a thing called "Plain old MassHealth". There is MassHealth Standard, and that is not going away (it's actually expanding). CarePlus is a new program created to take over a lot of soon-to-be expired programs. In actuality, about 80% of existing MH members had no changes at all. However, it's generally the people who barely qualified or barely didn't qualify under the old system that are having problematic hoops now.

FYI: I do not work for MH or the Health Connector, so if you are in either program you really should be proactive and make sure your case is being handled properly and not take too much other advice from random people on the internet. I just thought I would share a little of what I know from some old freelance work.

[prunesnprisms.livejournal.com]

TL, DR, because I do work in that space, but yes. :)

[clevernonsense.livejournal.com]

FYI, I checked with a contact of mine (10+ years working for masshealth) and she said that there is no open enrollment period in MassHealth - once you are in you can change providers any time. If true, that makes this still important but not as urgent/dire.

[chenoameg.livejournal.com]

Thank you for spreading the word.

[sairaali.livejournal.com]

Thank you for spreading the word. Ugh.

CeltiCare is the horrible company that administered my plan back in 2010, that refused to pay for emergency medical care because I didn't get an ER visit for massive hemorrhaging pre-authorized. They're awful.

[oneagain.livejournal.com]

If someone was enrolled in Mass Health Standard, nothing changed. Otherwise, if someone was enrolled in CeltiCare, they can call anytime to change it to a different provider, however it will not become effective until the 1st day of the following month. Additionally, it turns out that folks were diverted to CeltiCare, it turns out, from a systems error (or so it was explained to me) and if they have seen someone who does not take CeltiCare, apparently they need to just call Celticare and their bills will be honored, but they have to make a note in the file about it (and call Mass Health and change their provider).

[siderea]

Fascinating. Thanks.