Senate protects health safety net eligibility

The Massachusetts State Senate approved a $39.6 billion state budget proposal Thursday night, and it contains budget priorities for which MHA and the hospital/healthcare community advocated.

Through a budget amendment led by Sen. Jason Lewis (D-Winchester) and co-sponsored by 15 other senators, the Senate preserved current eligibility requirements for the Health Safety Net, which supports care provided to low-income uninsured and underinsured individuals. Earlier this year, the Executive Office of Health and Human Services finalized regulations scheduled to go into effect June 1 that would cut eligibility for the program by imposing substantial deductibles on lower-income individuals, reducing overall program eligibility based on federal poverty level guidelines, and shortening the time period for which the Health Safety Net will pay for services incurred.

The approved Senate provision would prohibit the changes until April 1, 2017, at the earliest. During floor debate on the amendment, Lewis noted that the driving force behind the Senate-endorsed delay is that “we remain concerned that we still don't fully understand how many people would be affected and what the impact would be in terms of bad debt for our healthcare providers as well as healthcare services for our patients that might be forgone.”

Hospitals have been fighting through the budget process to forestall those eligibility cuts and restore funding for the Health Safety Net. While Governor Baker’s proposal eliminated the state’s customary $30 million contribution to the Health Safety Net, both the House and Senate included $15 million in their respective budgets to partially restore the state’s contribution. An amendment effort to weaken the Senate restoration and allow the administration to spend less than the $15 million was defeated.

The Senate also approved an amendment led by Sen. John Keenan (D-Quincy) to create of a task force to examine the patient safety issues related  to insurer-forced “white bagging/brown bagging” of cancer and chronic disease medications.  Health insurers are increasingly changing benefit structures to require cancer and chronic disease patients to obtain certain injected or infused medications through a specialty pharmacy. The practice raises troubling questions about the safety of the medications, and the effect on patient out-of-pocket costs when insurers unilaterally switch the medications from a medical benefit to a pharmacy benefit.  

Other amendments of note adopted in the Senate budget include:

•        Requiring MassHealth to reimburse nursing homes for up to 20 medical leave of absence days (including observation stays in excess of 24 hours) and 10 non-medical leave of absence days.

•        Requiring $1 million to be allocated for new rate increases for providers in the MassHealth PCC mental health substance abuse plan.

•        Authorizing a new type of mid-level dental professional – the dental hygiene practitioner (DHP) – in Massachusetts. DHPs would increase dental access for vulnerable populations and make care more affordable.