Baker, a Republican and former CEO of
One change that the Baker administration is pursuing is to move more MassHealth patients from fee-for-service plans and into arrangements where a provider group is paid one fee to handle all of a patient's health care needs.
But the Massachusetts Hospital Associations says the change means deeper cuts in reimbursements to hospitals -- including Lawrence General and
"We believe such a policy that proportionally achieves so little benefit to the state at the great expense of hospitals is neither judicious nor justified," said
Hospitals have long complained that state and federal
In addition, Nicholas called the new approach "objectionable simply on principle" due to the government's interference in contracts between hospitals and private provider groups.
State officials are still hammering out details of an agreement with the federal government for five years of funding to implement parts of the Affordable Care Act. That includes
The state's shift from fee-for-service coverage is similar to efforts already underway on a federal level. For example, commercial insurers and
REPORT TOUTS MANAGED CARE
While the federal government provides funding, the state is expected to pick up more than half of those costs.
MassHealth represents more than one-third of the
The state also offers subsidized "safety-net" insurance through MassHealth to individuals who make too much money to qualify for most
About 40 percent of MassHealth patients are signed up for managed care plans. The state pays a fixed rate to the managed care groups, which contract with doctors to provide services and prescriptions.
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Rules and rates are set by the federal government.
A recent state legislative report recommended moving people off fee-for-service plans and into the managed care groups to lower costs. It also urged leaders to stop consumers from switching between health insurance plans, and recommended new eligibility requirements for the safety-net program.
But health care advocates say they're concerned about plans to eliminate benefits from MassHealth's fee-for-service programs -- such as reducing coverage for some services and restricting access to certain doctors -- as incentives to get people to switch to the new style of coverage.
"The benefit cuts are concerning because it could hurt patients' ability to get health care they need and stay healthy," said
Another concern is that patients who switch will be locked into a specific managed care plan for 12 months, she said, preventing them from changing providers if they aren't satisfied.
Advocates are also upset over the Baker administration's decision to lower eligibility requirements for the safety-net program from individuals earning four times the federal poverty level, or
"We recognize that health care costs are taking up a disproportionate amount of the budget and need to be brought under control," Curry said. "But we don't want to see that done at the expense of the state's most vulnerable people, by reducing their costs or benefits."
SAFETY-NET HOSPITALS FEAR LOSSES
Hospitals are concerned about plans to reduce funding by more than
Overall, state officials attribute cost increases at MassHealth -- which saw double-digit spending increases in 2014 and 2015 -- to high costs of health care, growing prescription drug costs, and expanded eligibility under the Affordable Care Act.
Baker has also faulted a decision by his predecessor, Gov.
Over the past year, the Baker administration has been reviewing MassHealth rolls, as required by federal law, to determine how many policyholders are actually eligible.
As a result, the state has dropped 250,000 ineligible participants from its rolls.
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