Date:
08/31/2009
Author: Neil Cronin
The Patrick Administration has announced its plan for continued
health coverage for immigrants losing CommCare Coverage beginning September
1st. As you remember, legal immigrants who are ineligible for federal matching
dollars were eliminated from Commonwealth Care, effective September 1st. The
legislature funded $40 million for the state to create an alternative program
for the so-called AWSS population. Here's what we know, so far.
- All AWSS immigrants will lose their Commonwealth Care eligibility at the
close of today, August 31st. Depending on categorical eligibility, these people
will have their benefits reduced to either MassHealth Limited or the Health
Safety Net effective September 1st.
- Starting in October, AWSS clients will begin to be enrolled into a new
managed care program which will be run by CeltiCare. Unfortunately, CeltiCare
does not yet have coverage in many parts of the state, but it promises to have
statewide coverage by December 1st. Therefore enrollment with CeltiCare will be
phased in over the fall as the network is established throughout the state. By
December 1st the program should be operating statewide. The metro-Boston area
will be the first served. Once an area of the state has a CeltiCare plan, the
member will have to sign up for it and use the CeltiCare network of providers.
(We don't know what, if any, provisions CeltiCare will make for patients who use
out-of-plan providers)
- Only those AWSS clients who were previously enrolled in CommCare will be
eligible for the new program. AWSS clients who weren't on CommCare in
August will not have access to CeltiCare, but will be eligible for the health
safety net.
- Patients will continue to have access to the Health Safety Net, and
MassHealth Limited, if eligible, until they are enrolled in CeltiCare.
- Benefits provided by CeltiCare will be similar to those provided under
CommCare with some exceptions. Dental, vision care, hospice, skilled nursing
services, and possibly other services are not covered.
- Patients will have increased co-payment obligations for certain services,
most notably a $50 co-payment for non-generic drugs.
There will be patients whose current care arrangements and provider
relationships will be disrupted because their provider or hospital is not
enrolled as a CeltiCare provider. As we learn more about the CeltiCare network
expansion, we will pass the information along.
Attached is a Q&A from the state explaining what's happening.
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