Caritas helps uninsured obtain coverage

BOSTON -- Over the last six months, Caritas Christi Health Care has assisted 30,000 patients in enrolling in the state’s mandatory heath insurance program, Commonwealth Care. The program, which was signed into law by Gov. Mitt Romney on April 12, 2006, began providing Massachusetts residents with insurance last October.

Assisting these patients in obtaining coverage is part of the Catholic mission of Caritas, said Terry Dougherty, Caritas’ vice president of payer relations and managed care contracting.

“We realize that the reimbursement for the services that we’re going to provide for these people is not on par with the commercial reimbursement that you would get from private insurance,” he said. “But this is why we’re part of Caritas. These are people who need our care, and we’re going to be there for them.”

Caritas elected to participate in Commonwealth Care, which is open to all hospitals in the state, Dougherty said.

“The ultimate goal is to provide everyone with health insurance and access to the health care system that exists in the Commonwealth,” he said.

The program aims to provide patients with the care without concern of undue financial burden. Caritas is making it a priority to help patients obtain insurance before they are in financial crisis, he said.

Estimates of the number of uninsured residents in the Commonwealth range from 250,000 to 400,000, Dougherty said. In Massachusetts, uninsured residents account for about six percent of the state’s total population.

“The uninsured population in the country is a growing concern for folks. Massachusetts happens to be unique, however. Our uninsured population is less than half the national average,” he said. “There’s a stark difference between Massachusetts and other states.”

The Commonwealth Care program, which requires all Massachusetts residents to have insurance, began the first of three rounds of enrollments in October 2006.

The first to be eligible for the program were residents living at or below the federal poverty line but who do not qualify for MassHealth, a public health insurance program for eligible low and medium-income residents. Individuals with an annual income of less than $10,000 or a family of four with an income of less than $20,000 a year, are not required to pay any premiums for Commonwealth Care.

The second round of enrollments began on Jan. 1, 2007 and included those with annual incomes of between 101 to 300 percent of the federal poverty level. This includes individuals who earn less than $29,000 annually and a family of four earning less than $60,000. This group is required to pay premiums based on a sliding scale that takes into account both income and family size.

The next round, which will include the remaining uninsured residents, will begin this July.

Since the process began, Caritas has not only enrolled over 30,000 people in Commonwealth Care but has enrolled another 50,000 in MassHealth, Dougherty said.

“As our financial counselors are trying to help people qualify for programs, they come to find that there are people who do qualify for MassHealth,” he said.

The benefits for Commonwealth Care are similar to those of MassHealth, he said. The coverage includes inpatient and outpatient hospital care, checkups with primary care physicians, vision care, prescription drug coverage, mental health and substance abuse services and dental coverage for those with incomes below the poverty line.

In participating in Commonwealth Care, Caritas Christi has instituted new policies in order to enroll both patients and doctors willing to participate, he said.

“All of the Caritas hospitals are working with the plan both to provide hospital care for the patients they insure but also with our nearly 1,600 physicians to also provide access to physician care,” he said. “We can give them the best health insurance in the world, but if we don’t have physicians who are willing to provide the care, the patient is again left stumbling around.”

Caritas also looked at all six hospitals and streamlined the process that patients go through to obtain insurance. Previously, patients would be greeted and go through registration and then contacted by financial counselors when they were billed, he said.

“What we have done is try to move as much of the financial counseling up to the front end so that basically changed the work flow,” Dougherty said.

Caritas has also contacted former patients who were uninsured when they visited the hospital in order to assist them in enrolling in Commonwealth Care. That effort is complicated by the fact that many of the neediest patients do not have stable housing and have moved since they received care, he said.

“That’s an ongoing effort. You can’t just do it for one month and think you’ll get everybody,” he said.

Enrolling patients before they have an emergency is key, he said. Those who are insured can have annual checkups with a primary care physician and may discover health problems before they end up in the ER.

“People will now be enrolled in a service product, which will give them preventive health care services,” he said. “Previously they came to the hospital when they had an emergency.”

Commonwealth Care not only assists patients, but it will benefit Caritas as well, Dougherty added.

“Last year alone Caritas provided nearly $30 million of free care that would have gone to the uncompensated care pool,” he said. “Ultimately the funds that have been going to the free care pool will be diverted to buy health insurance for people and the pool will shrink.”