Massachusetts Officials Halt Enrollment in Children’s Medical Security Plan

Citing higher-than-expected enrollment, Massachusetts officials on Nov. 4 will temporarily cease accepting patients in the Children's Medical Security Plan, the Boston Globe reports (Smith, Boston Globe, 10/26). Children in families that have incomes too high to qualify for Medicaid but cannot afford private health coverage are eligible for the program. Beneficiaries pay premiums based a sliding scale, ranging from no premium for a family of four earning less than $33,408 per year up to $52.50 per month per child for a family of four with an annual income of $66,817 or higher. The program covers primary and preventive care, including office visits, immunizations, lab tests, visits to specialists and up to $200 in prescription medicines per child per year (Freeman, Springfield Union News, 10/26). According to the Globe, state officials had budgeted for the plan to cover 26,000 children and assumed a growth rate of between 200 and 300 new beneficiaries per month. However, enrollment recently grew to between 500 and 600 new beneficiaries per month, and by the end of September, enrollment had reached 27,679 (Boston Globe, 10/26). According to Sally Fogerty, assistant commissioner of the state Department of Public Health, enrollment will not resume until participation in the program drops to below 26,000, which is expected to happen in January or February. Fogerty said that between 700 and 1,000 children leave the program every month for various reasons, including because they have reached age 19 and no longer are eligible (Springfield Union News, 10/26). Besides the halt in enrollment, the program beginning Dec. 1 will no longer cover emergency care until "at least next summer," the Globe reports. Emergency care for beneficiaries will be paid for out of the state's free-care pool, made up of funds from the state and hospitals. David Ball, vice president of the Massachusetts Hospital Association, said, "The state's answer is to put all its problems onto the free-care pool as if the free-care pool is a magic bullet. This is an action that will further imperil Massachusetts hospitals" (Smith, Boston Globe, 10/26). Hospital officials already had expressed concern about pressure on the free-care pool, which could face a $100 million budget shortfall this year, after the state cut 50,000 long-term unemployed adults from MassHealth, the state's Medicaid program (Kaiser Daily Health Policy Report, 10/21).