Managed Medicaid

MassHealth MCOs See Membership Grow With State's New Program

Reprinted from the April 19, 2007, issue of MEDICARE ADVANTAGE NEWS, biweekly news and analysis on the Medicare (and Medicaid) managed care programs.

Massachusetts has enrolled more than 60,000 uninsured people into the program created by its landmark 2006 health care reform law, and Medicaid managed care organizations (MCOs) serving the state's Medicaid beneficiaries have seen their enrollment grow as a result.

The law, enacted in April 2006, created the Commonwealth Care Health Insurance Plan for people earning less than 300% of the federal poverty level. According to the state, about 140,000 people are eligible. The legislation specifies that the four Medicaid MCOs now serving MassHealth (the state's Medicaid managed care program) would also serve the new program without outside competition until June 30, 2007, unless enrollment is less than 40,000 before that date.

As of April 1, 63,000 people had enrolled, and the total is expected to reach 70,000 by July 1, according to the Commonwealth Health Insurance Connector Authority, the state agency created by the 2006 law to oversee the reforms. Since that exceeds the goal, the MCOs may continue serving the program until June 30, 2008. If enrollment is less than 80,000 on that next date, lawmakers may decide to open up the program to other health plans, according to the statute.

Christina Severin, CEO of Network Health, says the company has signed up 27,000 Commonwealth Care members since the program started enrollment Oct. 1.

"When you work with the Medicaid population, a lot of your job is teaching them about the health care system," Severin says. The situation is similar with the new members. One Commonwealth Care member told Network that he hadn't been to a doctor in 10 years, she says. The MassHealth plans also already have access to low-literacy materials and multilingual materials.

Severin adds that many low-income Medicaid beneficiaries are in the program for only about a year because of federal rules on participation, but now will have Commonwealth Care to fall back on. She uses the example of a woman with diabetes: "We have worked with her in our [MassHealth] care management programs for a year, and now she can go into Commonweath Care and stay in our network so we can continue to work with her," she explains.

Plans Express Optimism About Program

Deborah Enos, president of Neighborhood Health Plan of Massachusetts, says the plan has 11,000 Commonwealth Care members, and that "this summer and early fall will put the meat on the bones" in terms of adding enrollees. She says it's too early to comment on financial results for the program so far. "We're just a few months into it in terms of claims, but we felt when we did the actuarial work that the rates proposed were sound," she tells MAN.

Jean Haynes, executive director of Boston Medical Center HealthNet Plan, says it has enrolled 27,000 members in its Commonwealth Care product. "Developing and implementing our new product.in a very short window of time (a little over two months) was a tremendous operational challenge, but our staff responded heroically and did a fantastic job," she says.

"[BMC] has more than 10 years of expertise in managing care for low-income populations....In addition, the four Medicaid MCOs had existing organizational relationships with the state government, in particular the Medicaid office, which greatly expedited the very fast turnaround to get Commonwealth Care to market," Haynes explains. "We remain very optimistic about continued growth for Commonwealth Care as more and more Massachusetts residents learn about the program," she adds.

The fourth MassHealth plan, Fallon Community Health Plan, now has about 1,300 Commonwealth Care members and is increasing its marketing efforts, says spokesperson Robert Nolan. "Once the landscape is defined by the currently evolving regulations, this will become a solid vehicle to extend health plan coverage to thousands of people who do not currently have it. We expect it to experience solid growth over the next few years," he says.

Nolan says organizations across the country have contacted Fallon for information about the reform. "There is a lot riding on the success of Commonwealth Care in Massachusetts and in terms of the national agenda," he says.

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