November 1st, 2014

MassHealth woes could be resolved soon

The nightmare may soon be over for some Massachusetts psychologists and their clients who were placed on a temporary insurance plan that did not cover all their therapy needs.

Earlier this year, the Massachusetts Health Connector, the state’s online health insurance exchange Web site, was not functioning for new enrollees for subsidized health insurance. The state responded by placing some 31,000 people on a temporary plan until the site could be made operational.

The fix, meant to ensure a smooth continuation of coverage for these Massachusetts residents, instead left a gap that the Massachusetts Psychological Association has been fighting to get closed ever since. The temporary plan did not include the normal carve-out coverage for outpatient therapy by independent psychologists because of a 2003 regulation that prohibits MassHealth from covering these services.

The state did not seem to make any attempt to rectify the situation, instead directing temporary members to seek care from community centers. In June, James Leffert, Ed.D., chair of the advocacy committee for the MPA, explained that he had contacted MassHealth and was told that the member had to call customer service to follow up but that “as long as the member has temporary coverage, he will need to apply to a community mental health clinic.”

The good news is that the problem should be fixed by the end of the year for most of the temporary clients. While the state did not add MBHP coverage in the interim, there are promises that a new Web site will be up and running for open enrollment by Nov. 15.

“We are going to have a viable web system in place starting Nov. 15, and we are strongly encouraging members to take action as soon as possible once open enrollment starts,” says Jason Lefferts, director of communications for the Commonwealth Health Connector.

“Temporary coverage will be transferred out in three waves, on a first-in/first-out basis,” he adds. “Those end dates are Jan. 15, Feb. 1 and Feb. 15.”

Michael Goldberg, Ph.D., director of professional affairs for the MPA, has taken a lead in attempting to resolve this issue over the past six months. He holds out hope that the immediate issue will soon be rectified.

“There is clearly light at the end of the tunnel,” he says. “I have been told by a source that the pressure we brought increased the pressure on the officials to fix the entire system sooner rather than have to create work-arounds to address the mental health issue. Whether this is true or not we’ll never know, but we certainly did make noise throughout MassHealth and on Beacon Hill.”
In order to keep this issue from ever happening again, Goldberg has been pushing to get the 2003 legislation changed and has had reassurance that there will be movement in that direction.

“The commitment to work on changing the regulation came from the director of behavioral health for MassHealth,” he says. “However, the political reality is that, with the impending election of the governor, there are likely to be significant changes throughout the administration. Thus, getting things done in advance of the appointments of new commissioners and agency directors is difficult. I am hoping that we will have a governor in 2015 that understands the importance of access to behavioral health services and will be a champion for our causes such as this issue.”

By Catherine Robertson Souter

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