"Stuff happens. Always does. The issue is what happens next." by Brian Rosman

Last week we learned that the Connector had a major mess on its hands. Apparently, thousands of notices (affecting as many as 16,000 people) were not sent out on time to Commonwealth Care members and applicants. As a result, these people may have lost or will be losing coverage, through no fault of their own. We discovered the problem when our Helpline got dozens of these notices on the same day. We quickly got on the phone with other groups doing enrollment work, and figured out that something went wrong.

The Connector is trying to find a solution to the problem. We draw three lessons from what’s happened so far:

1. The continued need for outreach and education: The state now provides modest grants to 45 non-profit community groups to fund outreach and education efforts statewide. For the past two years, much of their work has been oriented towards getting people to sign up. Now, the focus is helping people stay enrolled, with continuous access to care.

Every MassHealth and CommCare member must re-enroll annually, and the system can be daunting. The community groups receiving the grants have built up the trust and expertise to work with people who need individualized help.

Renewal of the grant program (which is half federally reimbursed) is now pending before the legislature’s budget conference committee; we urge them to continue the program.

2. The need for effective communication: State officials learned about the delays in late May. Several networks exist for getting the word out, but that state initiated none of these so far. We discovered the problem from our Helpline, not any official source. State officials shouldn’t be wary about being open with advocacy groups about concerns. Early warning would have allowed those of us working with the program to collaborate, find answers and communicate them to the public.

3. The critical need for retroactive coverage in CommCare: Unlike MassHealth, the Commonwealth Care program is generally unable to retroactively provide coverage when someone is wrongfully terminated. Bureaucratic mess-ups are bound to happen, but under the current system, there’s no way to amend the mistake. Gaps in coverage also occur when someone transitions between coverage sources. For someone in the middle of vital medical treatment, this can have serious consequences. The Connector recognizes this as an issue, and has asked for patience while they work on the problem. We think this must be a top priority for the near term.

Brian Rosman
Research Director, Health Care for All