State, Personal Errors Lead To Wrongful Coverage Termination For Some Commonwealth Care Beneficiaries

Main Category: Health Insurance / Medical Insurance
Article Date: 27 Aug 2008 - 6:00 PDT

email to a friend   printer friendly   view / write opinions   rate article

Since January, Commonwealth Care coverage for tens of thousands of Massachusetts residents was wrongfully terminated either because of their own mistakes or errors made by the state, according to enrollment data, the Boston Globe reports. The enrollment data do not show how many people later re-enrolled in the program or how many of the cancellations were erroneous. State officials say that fewer than 100 residents' coverage policies may have been wrongly terminated, but lawyers and community advocates say they have seen a consistent number of residents whose insurance was wrongly rescinded by the state, the Globe reports.

Advocates said that some residents may have made errors while completing the enrollment forms, which include complicated eligibility documents. Other reasons included wrong mailing addresses of residents and a misinterpretation of the residents' information. As a result, those whose coverage was terminated could "unknowingly rack up thousands of dollars in medical bills only to discover that those expenses will not be reimbursed," and the only way they could get reimbursed would be to file a lawsuit against the state, the Globe reports.

Melissa Boudreault, director of Commonwealth Care, said that the Connector's board was aware of fewer than 100 wrongful terminations. State regulators hope to conduct an overhaul of the large computer system that manages Commonwealth Care and MassHealth by January, which should alleviate the problem of wrongful coverage rescissions and efficiently provide reimbursements to those whose coverage was dropped, Boudreault said. She added, "If we are made aware of an instance where medical debt was incurred, or someone needs to see a doctor, we work on a case-by-case basis to resolve those issues."

Jennifer Kritz, a spokesperson for MassHealth, said the state is updating its mailing system and revising the current documents for annual coverage renewal to make it easier to understand. Kritz said, "MassHealth is keenly aware of this issue and has a shared interest with members, providers and advocates to prevent disenrollments whenever possible."

The leaders of the two health insurance companies that provide coverage for most Commonwealth Care beneficiaries said that members frequently seem to be terminated by the state and then re-enroll in a plan several months later.

Barbara Anthony -- executive director of Health Law Advocates, which has sued the state on behalf of some beneficiaries whose coverage was terminated -- said, "This is an issue of fairness," adding, "I think there would be a huge outcry by state government if a private insurance plan behaved that way" (Lazar, Boston Globe, 8/23).

Letter to the Editor
A recent Boston Herald editorial noted that "health care reform is working, with nearly a half million people newly insured," but with "this success come challenges" because "the state budget is being strained as strong enrollment has driven up costs for health coverage," Massachusetts Administration and Finance Secretary Leslie Kirwan and Massachusetts Health and Human Services Secretary JudyAnn Bigby write in a Herald letter to the editor.

Kirwan and Bigby write, "We recognize and appreciate employers' role in expanding private insurance," but "just as many employers have stepped up in this regard and consumers are paying more for state health coverage, we are asking providers, health plans and businesses that have not done their fair share to do so," adding, "Otherwise, we are faced with imposing additional burdens on individual taxpayers or depleting our state's rainy day reserves." Kirwan and Bigby conclude, "Along with cost containment initiatives, shared responsibility will enable us to achieve the full promise of health care reform" (Kirwan/Bigby, Boston Herald, 8/25).

Reprinted with kind permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation.

© 2008 Advisory Board Company and Kaiser Family Foundation. All rights reserved.