Health coverage, cost trends serving double whammy

With hundreds of thousands of Bay Staters expected to lose their vitality coverage due to federal initiative changes industry leaders and state agents mapped out broad strategies to combat a looming surge in uninsured residents Around residents will lose coverage through MassHealth and the Massachusetts Wellbeing Connector announced Audrey Shelto CEO of the Blue Cross Blue Shield of Massachusetts Foundation New Medicaid work requirements and more frequent redetermination requirements that will take effect in under the One Big Beautiful Bill Act are projected to double the rate of uninsurance in the commonwealth Shelto stated This law makes it unbelievably harder to qualify for MassHealth to get enrolled in MassHealth and to stay enrolled in MassHealth Shelto reported at the Healthcare Agenda Commission s annual hearing on cost trends which this year veered into discussion of projected coverage trends Insights shared from providers vitality system leaders insurers state agencies and other stakeholders help the HPC establish a yearly strength care spending rise benchmark The state in fresh years has far eclipsed the metric putting pressure on individual business and establishment soundness care payers The benchmark was set at for after the improvement rate of total physical condition care expenditures rose by from to Massachusetts now posts the highest family vitality insurance premiums in the country and the average annual cost of soundness care for a family exceeded including out-of-pocket spending in according to a letter in the hearing project from HPC Executive Director David Seltz and Board Chair Deborah Devaux The average annual cost sharing per person increased from in to in The volume of residents paying or more in annual cost sharing also doubled from to Seltz stated employers are shifting costs onto their workers While one in five people with commercial coverage was enrolled in a high-deductible plan in that figure approached in he commented Survey results tell us that patients and residents who have high-deductible wellness plans are much more likely to have physiological debt and they re much more likely to document having gone to the urgency department for a condition that doesn t need crisis department level of care Seltz mentioned Changes Under the One Big Beautiful Bill Act individuals who are ages - and those enrolled through the Affordable Care Act expansion group will need to work or participate in other qualifying events for at least hours each month to remain eligible for Medicaid coverage according to KFF There are exemptions including for individuals who are medically frail States must also redetermine eligibility every six months as opposed to the current yearly requirement under the new federal law Massachusetts is expected to lose billion annually once all components of the law take effect Shelto noted The state is going to have to make a few really really hard decisions Shelto declared I m sure that chosen of the decisions will be what holes can the state close But several of the decisions are also going to have to be who gets covered What do they get for coverage What do providers get paid Mike Levine undersecretary for MassHealth described job number one as ensuring that as a multitude of members retain their coverage as feasible amid the federal changes He also offered a four-pronged approach as MassHealth handles new work requirements including ascertaining which members do not need to comply with those rules automatically determining which members already comply with the requirements conducting outreach to individuals and communities who must take action to stay on the MassHealth rolls and helping to connect members with qualifying events in order for them to remain eligible I ll give you an stimulating statistic from our redetermination efforts two years ago We managed to get our auto-renewal rates up by over percentage points just by doing a better job of material matching and linking people to income records so that they never had to fill out a form or get an envelope Levine reported They just got a piece of mail that noted You re good we ll see you in a year We want to do that with as multiple people as workable for work requirements and take advantage of evidence sources your income higher tuition volunteer association you name it so that people don t have to lift a finger Michael Curry CEO of the Massachusetts League of Society Vitality Centers noted the looming wave of uninsured patients is deeply concerning to us Around of patients at robustness centers are on Medicaid and the centers also serve of the state s uninsured population Curry mentioned Massachusetts is also grappling with new guidance surrounding the MassHealth Section Demonstration Waiver as executives work on extending it beyond The waiver gives Massachusetts flexibility over Medicaid policies and over designing and improving programs according to a state webpage When we get ready to negotiate our waiver we can no longer access the federal workforce programs and initiatives that we go into this waiver with for any new effort Curry commented So when we as group strength centers rely heavily on our Medicaid operation our efforts I should say to really be innovative about how do we recruit retain our workforce and particularly diverse workforce in the commonwealth that decision concerns us Federal immigration policies particularly lapsed or revoked work permits are also straining the healthcare care workforce Levine commented the loss of work authorizations is causing a crucial impact for long-term care services and supports including nursing homes and community-based care Perennial issue While Wednesday s hearing revolved heavily around the federal robustness care landscape affordability and access challenges pre-date the Trump administration commented Attorney General Andrea Campbell Now with a federal leadership that is possibly making premiums higher under the ACA making it more laborious for folks to access food the innovation must continue not only because it will then demonstrate to others in the country how to do it but if we were able to revisit the benchmark issue and also come up with selected legislative solutions and other solutions we can get ahead of the increases we can get ahead of the accessibility issues Campbell explained reporters Appealed to clarify what legislative or benchmark interventions entail Campbell commented her office is focused on monitoring the entry of new for-profit entities into Massachusetts to prevent another situation like the Steward Strength Care bankruptcy predicament The AG also expressed an openness to working with Beacon Hill and the Healthcare Agenda Commission They re not all within our wheelhouse but we do have thoughts and ideas Campbell declared And I think it s time for a more robust conversation given that the federal regime is nowhere to be located in helping us reduce costs and reduce accessibility issues U S House Speaker Mike Johnson and other congressional Republicans have announced the Medicaid work requirements are aimed at eliminating waste fraud and abuse Y ou eliminate fraud waste and abuse you bring in work requirements and you tighten up the initiative and you can find a lot of savings Johnson reported in April as he noted the program change will ensure illegal aliens are not receiving Medicaid coverage The whole idea is that we re trying to preserve the campaign Johnson revealed Residents enrolled in plans through the Massachusetts Wellbeing Connector will experience the the bulk immediate disruptions tied to the federal authorities stated Executive Director Audrey Morse Gasteier In January about noncitizens who are lawfully present here will lose access to heavily subsidized ConnectorCare plans under a framework change in the One Big Beautiful Bill Act Thousands of other Bay Staters are also facing steep premium increases though they could see relief if Congress decides to extend enhanced premium tax credits that are set to expire at the end of the year We have been inundated in our call center noted Morse Gasteier as she reflected on the first days of open enrollment We are hearing from people in duress We have seen an uptick in threats of self-harm The degree of duress that is out there as folks contemplate losses of subsidy and these really striking premium increases is profound