fb-pixel

Health care providers brace for confusion as new Mass. Medicaid rules are rolled out

Secretary of Health and Human Services Marylou Sudders.
Secretary of Health and Human Services Marylou Sudders.Suzanne Kreiter/Globe staff

More than 800,000 Massachusetts Medicaid recipients enter a new era Thursday with the rollout of sweeping changes that are designed to improve care and save money — but that could cause initial confusion and disruption.

State officials are trying to more tightly control where patients on the Medicaid program, called MassHealth, receive their care. They have assigned patients to one of several different accountable care organizations — or networks of doctors and hospitals that will work to manage patients’ care.

While the Baker administration’s goals have broad support, a change on this scale is likely to run into early problems.

“There will clearly be disruption for patients,” said Dr. David C. Osler, a Somerville pediatrician.

Advertisement



“To me, as a pediatrician in the community who has a large number of MassHealth patients, it seems that it’s putting those patients at a great risk of patient error, [and] separating complicated patients from preexisting relationships, forcing them to make choices that are somewhat arbitrary.”

“It just raises a level of anxiety and stress for families one more notch,” he added.

MassHealth, a taxpayer-funded program, serves low-income individuals and families.

As program changes get underway, patients will have to figure out which doctors they can continue to see under the new rules. Some will have to choose whether to keep primary care doctors they have seen for years, or specialists they have come to trust.

MassHealth members have until May 31 to switch networks; they will then be locked in for nine months.

MassHealth officials sent more than 1 million letters to inform members about the coming changes in November, but it could still take weeks or months for members to fully understand their new health plans.

They will have to learn the name of the network they’re in (there are 17), which hospitals and specialists are included in that network, and what new benefits may be offered.

Advertisement



“This is going to be a big transition for people,” said Thomas A. Croswell, chief executive of Tufts Health Plan, which is working with several accountable care organizations. “Without a doubt, it’s going to be confusing for some folks.”

Tufts and other local health care companies said they have staff available to field questions from MassHealth members.

“At some point, you have to flip the switch,” Croswell said.

Marylou Sudders, the state’s secretary of Health and Human Services, attributed concerns about the redesign of MassHealth to the anxiety that comes before any significant change.

“We are completely committed to smooth transitions,” Sudders said. “If we hear disruption, if we hear worries out there that are more than anticipatory anxiety, we will respond. We have to.”

MassHealth officials said they have more than 200 workers who are specially trained to answer calls about accountable care organizations.

Last week, they received about 5,000 calls a day with questions about the changes. That number is expected to climb.

They have also launched MassHealthChoices.com, an informational website.

The restructuring of MassHealth is among the most significant health care initiatives to come from the administration of Governor Charlie Baker, a Republican who has been focused on containing the costs of the massive program. MassHealth accounts for some $16 billion in annual costs, which are shared by the state and federal governments.

The move to accountable care is designed to allow health care providers and insurers to closely track and manage each patient’s care. Many patients will get access to new services to manage their medical conditions and prevent hospital stays, which ultimately are expected to help rein in costs.

Advertisement



The restructuring of MassHealth will also allow health care providers to work with social service organizations to help address nonmedical but critical needs, such as for healthy food and housing.

Another significant change is how MassHealth will pay for care. Some of the reimbursement that health care providers receive will be tied to how well they perform on a set of measures that track the quality and outcomes of care.

Under an agreement with federal officials that was struck during the final weeks of the Obama administration, the state is required to reduce the growth of spending in MassHealth by 2 percentage points by the end of 2022.

In the near term, to help manage the changes, MassHealth officials will allow a grace period of at least the next 30 days so patients can keep any appointments already scheduled during that time — even if they’re visiting doctors who are no longer in their network.

After that, it will be much harder for patients to seek care outside their networks. This means, for example, that some patients will lose access to specialists at hospitals such as Massachusetts General and Brigham and Women’s, which are owned by Partners HealthCare, if they don’t also get their primary care from a Partners doctor.

Advertisement



Dr. Eric Weil, chief medical officer for primary care at Partners, said it’s working to complete agreements with several other health care networks to allow their patients to keep seeing specialists within the Partners system.

“We are very committed to making sure these patients have as much access to us as before,” he said.

State officials have been planning this overhaul of MassHealth for years, and the health care industry has been preparing for the changes.

But earlier this week, the South End Community Health Center in Boston was still waiting for an updated list of patients assigned by MassHealth to the health center’s network, said chief executive Bill Walczak.

“We’re anxiously awaiting Thursday to see if all of a sudden everything is going to work, or whether we’re still going to have problems,” he said. “Things really need to come together really quickly.”

Jonathan Chait, a Western Massachusetts resident who is covered by MassHealth, has spent several hours making phone calls in recent days to try to understand the coverage changes — only to receive confusing or incomplete information from the state and his medical providers, he said.

Chait worries that he will lose access to some of his specialists.

“The changes are creating chaos,” he said.


Priyanka Dayal McCluskey can be reached at priyanka.mccluskey@globe.com. Follow her on Twitter @priyanka_dayal.