Commonwealth Care Alliance members left in the dark amid financial crisis

If Amanda Sturtevant attempts to wash her dishes, she sits close to eye level with the kitchen sink.

The 39-year-old is disabled and uses a wheelchair, living alone and independently inside a sand-colored mobile home in Ludlow. She works from home as a call service representative, taking after-hours inquiries for doctor’s offices and oil companies.

A home health aid, who Sturtevant called her “savior,” visits twice per week. The aid does her laundry, dishes and all of the basic tasks that aren’t easy to accomplish given her mobility status. The mobile home itself isn’t accessible, and there aren’t any accommodations for Sturtevant to safely come and go.

A situation unfolding across the state involving Sturtevant‘s dual insurance and care provider, Commonwealth Care Alliance (CCA), could endanger the services she and approximately 45,000 other Bay Staters desperately need. CCA is running out of money.

And yet, until this week, Sturtevant didn’t even know about it.

“Not even a hint,” she said. “And if I didn’t know, and I use the internet every day, [there are people who] ... have zero idea of what’s coming. If I lost CCA and I lost aid, I would survive, but it would be hard. Some of these people won’t survive.”

State records show the Commonwealth Care Alliance, a Boston-based integrated health insurance and care management nonprofit organization, faces financial troubles that could soon reach a boiling point. Potentially imperiled is the health care and coverage for some of the state’s most vulnerable — tens of thousands of people who are disabled, elderly and low-income.

CCA doesn’t have adequate funds to comply with the solvency reserve requirement — a mandatory amount of cash on hand that ensures financial stability — in its two contracts with MassHealth. The nonprofit is looking for a buyer, but a sale hasn’t materialized.

The state is making preparations in case the organization falls apart, while advocates' calls for temporary receivership are growing louder.

CCA declined to answer questions or provide comment for this story.

Founded in 2003, CCA has historically been viewed as a leading model for combining insurance and health care for the Medicaid/Medicare crossover population. The nonprofit coordinates medical and social wraparound services for individuals, including physical and occupational therapy, homemaking, personal care, behavioral health, transportation to appointments and more.

Jill Keough, executive director of Greater Springfield Senior Services, said it’s time to “ring the alarm” about what is transpiring within CCA.

“I’m worried that there isn’t going to be a safety net for these people, ” said Keough, whose organization provides care for more than 5,000 CCA members. “We have to be their voice.”

There hasn’t been any public communication from CCA itself about the unraveling situation — it was a Boston Globe article earlier this month that broke the news, in the eastern part of the state at least.

Bill Anjos, president of Interim HealthCare in West Springfield, a personal care and homemaking services company, said it’s likely most people affected in Western Massachusetts “aren’t even aware their services are potentially in jeopardy.”

“If CCA were to become insolvent and stop providing services, they would be left in the lurch,” Anjos said. “It’s terrible.”

Assistance through CCA ensures someone bathes twice a week or sees groceries appear on the kitchen table, he said.

CCA has ‘less than zero cash on hand’

In 2022, CCA was overseeing care for 100,000 people across four states while making investments in other health care companies, the Boston Globe recently reported.

Meanwhile, state records show the organization was suffering millions in operating losses each year: $14.3 million in 2022 and $105.8 million in 2023.

Last October, signaling the financial tumult, CCA announced it would exit all Medicare Advantage plans in California, Michigan and Rhode Island and focus mainly on its Senior Care Options (SCO) and One Care plans in Massachusetts.

Notices obtained by MassLive show MassHealth began warning CCA in October that it was out of compliance with solvency reserve requirements. Reserves for CCA’s SCO and One Care contracts were deficient by more than $200 million, the notices addressed to President and CEO Christopher Palmieri stated.

MassHealth wrote CCA projected “having less than zero cash on hand during Q1 of (calendar year) 2025.”

Effective Nov. 1, 2024, MassHealth imposed a temporary enrollment freeze on both plans for new members and related marketing activities. CCA was directed to develop a corrective action plan.

A MassHealth spokesperson said the agency instituted the enrollment freeze “to protect members” while the organization “addresses its solvency issue.”

“We are deeply committed to the One Care and SCO programs and ensuring excellent care is provided to our members and will continue partnering with CCA as they work to comply with our contract,” the spokesperson told MassLive.

But the state is also working a plan B, seeking proposals from vendors who could potentially take over the intensive work of patient coordination that CCA has historically done, in the case patients have to switch to regular MassHealth coverage.

Simultaneously, the state is positioning itself as willing to step in to keep CCA’s Boston and Springfield primary care clinics running if required, according to MassHealth.

In addition to its thousands of members, CCA’s dicey status jeopardizes the finances of the many providers it contracts with, who in turn provide countless jobs.

According to CCA’s 2021 Form 990 filing with the IRS, the most recently available in the state’s public charities portal, CCA paid 997 independent contractors more than $100,000. Some were paid tens of millions.

The highest-paid contractor that year was Stavros Center for Independent Living in Amherst, receiving $66.5 million from CCA, followed by Tempus Unlimited in Stoughton ($62.7 million) and Northeast Arc in Danvers ($42.9 million).

CCA paid Greater Springfield Senior Services, for example, nearly $3 million for its work with nearly 5,100 members.

CCA member: ‘To lose it would be devastating for me’

Darlene Harris, 69, rents a home with a roommate in Chicopee. She has been physically disabled for “many years,” she said, and soon might undergo long-awaited back surgery.

“I’m at the point where I can’t do a lot of stuff,” Harris said. “I can’t stand for too long.”

Her CCA personal care aid comes to the house five days a week, helping with shopping, dressing and cooking. Harris said laundry assistance is “essential” because her washer and dryer are in the basement.

“I can’t do stairs,” she said. “I haven’t been in the basement in almost two years now.”

Harris likes to crochet and play games online during her days at home. She would be in “trouble” if she lost the services provided through CCA, she said. All of her family members live out of state.

“I think it’s really sad that all this crap is going on,” Harris said. “To lose it would be devastating for me. It would be a life-changer.”

Magy Ramos, managed care and MassHealth director at Greater Springfield Senior Services, said the care provided through CCA enables many individuals to remain safely in their homes. CCA also works within institutional settings such as nursing homes and assisted living facilities.

“I think everyone needs to understand that these are individuals that are at a low-income bracket,” Ramos said. “They are already stuck in a bubble. They don’t know much but the services that surround them. When you leave them alone without all of these resources, when you leave a community alone, you should expect there’s going to be negative impacts for everyone, including all of the jobs of individuals providing care.”

Interim HealthCare in West Springfield provides personal care and homemaking services to approximately 50 CCA members per month. Anjos told the story of one man with a schizophrenia diagnosis who they visit seven days per week, “keeping him on track” and in a routine that is critical to his wellbeing. He has no family in the area.

“Without the help from CCA, he would have nobody,” Anjos said.

Sturtevant, the CCA member who lives in Ludlow, wants the organization to answer for what is happening. She “can’t imagine” having to start over with a new insurance and care plan. Managed care organizations like CCA bring Medicare and MassHealth together. Otherwise, people have to go through two separate avenues for care that ultimately aren’t coordinated.

“My biggest concern with this is because CCA is primarily geared toward the disabled and the elderly, how could they mishandle it?” Sturtevant said. “They need to get it together because it’s going to affect tens of thousands of people.”

Will the state pursue receivership?

CCA is looking for a buyer to purchase the organization, according to MassHealth. But a February letter sent by disability advocates to Gov. Maura Healey, Attorney General Andrea Joy Campbell and the state’s Department of Insurance, imploring them to pursue temporary receivership, stated that “no acquisition is imminent” and members are at increasing risk.

The letter from law firm Health Law Advocates, sent on behalf of the Boston-based Disability Policy Consortium, called CCA a “bedrock organization” whose members must be urgently protected.

“Its pioneering person-centered, team-based model of care was developed to be member-directed and tailored to members' needs to optimize health outcomes,” Health Law Advocates wrote.

The letter advised the state to pursue temporary receivership, the aim being “the rehabilitation of CCA.” Receivership would ensure members can continue to access the care they need now and in the long-term, the advocates said, preventing a major disruption in Massachusetts' health care system.

Temporary receivership is a legal solution where a court appoints a person or entity to temporarily manage a business asset while financial issues are resolved. In this case, it would essentially be a mechanism to save CCA from going under.

“Allowing for the dissolution of CCA is the last option the state should consider,” the letter said, citing the high percentage of CCA members with complex needs that other health plans could not easily take on.

CCA’s 2021 annual report showed more than 72% of members had a physical or behavioral health disability, 25% had a substance use disorder and 7% had a complex physical disability.

Health Law Advocates cited a precedent for the successful temporary receivership of a Massachusetts health insurer. In 2000, the Department of Insurance intervened when Harvard Pilgrim Health Care faced financial issues. After stabilizing the health plan, the state’s Supreme Judicial Court approved a final rehabilitation plan that positioned the insurer to move forward without state oversight.

Care providers such as Keough and Anjos agree that temporary receivership is the immediate solution. Anjos recently wrote to state Sen. John Velis, D-Hampden/ Hampshire, urging the Legislature to assist.

Velis' legislative director told Anjos in an email the senator is “beginning conversations with his colleagues.”

The Attorney General’s Office is monitoring the situation, as well.

“Our office understands the potentially serious effects that any disruption of care coordination could have on the communities served by CCA,” a spokesperson for the office said in a statement to MassLive when asked about potential receivership. “We are closely reviewing this matter while we assess appropriate tools to minimize potential impact.”

Keough, executive director of Greater Springfield Senior Services, hopes CCA will take greater accountability in communicating to the public.

“I think the frustrating part is we are learning about this through the rumor mill or I just happened to stumble across that Boston Globe article,” she said. “We’re sort of finding out after the fact that these issues are occurring.”

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