Saturday, June 21, 2003 - 2:15:30 AM EST
By Jack Dew
Berkshire Eagle Staff
When the state ended its MassHealth Basic program on April 1, Joyce Perras, a 61-year-old Adams woman with multiple sclerosis, stopped taking the medication that helps her walk, soothes her headaches and clears her double-vision.
She has gone without the drugs that make her life more comfortable because, without health insurance, she cannot afford the $500 cost of a one-month supply of pills. Yesterday, when Perras learned the Legislature had restored funding to MassHealth Basic that will allow her to resume taking her medication, she cried.
"They don't want the old people to live," Perras said of the way she felt when the state first cut her health insurance. "I have been working since I was 16, working all my life, paying Medicare, paying taxes, this and that. Where did all the money go? I'm only 61, and they don't want me to live."
Perras and 36,000 others will regain coverage from the state under MassHealth Basic, a Medicaid program that provides health care to the long-term unemployed, including an estimated 1,200 in Berkshire County.
Statewide lobbying effort
The restoration was the brightest news in the state budget for local health officials and advocates. They had joined in a statewide lobbying effort begging the Legislature to spare Medicaid programs already hard-hit in recent years by the slouching economy and shrinking state contributions. Also welcome was a provision that will keep alive the Prescription Advantage program, which provides drug coverage to senior citizens and the disabled.
As officials yesterday tried to parse the budget language and determine how closely the resurrected MassHealth Basic will resemble its former incarnation, there were dozens of unanswered questions. It was not clear when the program will resume: Some thought it would start on July 1, the beginning of the state's new fiscal year, while others said it may not come back until Oct. 1, the start of the fiscal year for hospitals.
Still others were not sure where Basic enrollees would be able to go for treatment. The language that emerged from a House and Senate conference committee said patients could only go to specially licensed health centers and mental health providers. The only facility in Berkshire County that meets that definition is the Community Health Center in Great Barrington, but the bill made an exception for people who face "geographic issues," which may or may not include the hilly, sparsely populated Berkshires.
The Executive Office of Health and Human Services, which administers Medicaid in Massachusetts, was still going over the budget language yesterday and had not yet determined what MassHealth Basic will look like under the new scheme. "The devil is in the details," said spokesman Richard Powers. "It is too early to say."
At agencies like Advocacy for Access in Pittsfield and Ecu-Health Care in North Adams that try to pair the uninsured with health coverage, the Legislature's budget was surprisingly good news. The earlier House version had left out MassHealth Basic as part of an effort to close a $3 billion budget gap, and the Senate had restored the program. That put it in the hands of the joint conference committee, which released its compromise budget on Thursday.
"I think they realized that these people are not people who are sitting at home and not working and demanding that the state give them health insurance," said Pat Duma of Advocacy for Access. "I have never seen people like that at all. The people that I see coming through our door are at their limits, scared to death and sick."
In the past week, Duma said her agency had seen 20 people whom she could place on MassHealth Basic, not to mention the roughly 500 people her office deals with who were thrown off the plan when it ended April 1. Many of them have since applied for disability coverage, which could put them on standard MassHealth if the state recognizes them as having a long-term illness or injury.
At Ecu-Health Care, Charles "Chip" Joffee-Halpern said: "We are still looking at the bill and trying to completely understand it. But it is a great start, and I applaud the Legislature for making an effort.
The budget held some grim news, however, for other popular health plans. It will deny coverage to 4,300 HIV-positive patients statewide by capping enrollment and rolling back the income eligibility from $17,960 a year for a single person to $11,943 a year, according to the advocacy group Health Care for All. It will also underfund the Children's Medical Security Plan and cap its enrollment, the group said, eliminating coverage for at least 7,000 children in Massachusetts.
The Legislature also did nothing to replace cuts made to inpatient substance abuse treatment, a segment of health care that relies heavily on public funding.
At the McGee Unit on the Hillcrest campus of Berkshire Medical Center, the publicly funded detox beds were cut in half, from 30 to 15. While it can still treat up to 30 patients at a time, no more than 15 of those can be covered by Medicaid or a separate program administered by the Department of Public Health.
While McGee expects those 15 beds to be sufficient, the much larger blow has come in the dramatic reduction of treatment time. Under the old system, a heroin addict could enter treatment and spend six days going through withdrawal. The patient could then graduate to a six- to 10-day stay in McGee, where they could undergo addiction counseling and try to ready themselves for release, often to a halfway house.
Under the new rules, that second, six- to 10-day phase has been eliminated, so that patients will go straight from withdrawal to release.
"This is the biggest mistake I think the state has ever made in addiction treatment," said Donald Scherling, program director of the McGee Unit. "Getting someone detoxed where they are not in physical danger is just the very, very foundation of recovery. People still don't have the tools to recover, especially dual-diagnosis patients with mental health issues as well as addiction."
Also troubling, Scherling said, is a state mandate that McGee can only treat an average of 3.75 patients a day whose care is paid for by the Department of Public Health. If the unit creeps above that average as the fiscal year grows older, it may have to turn indigent patients away.
But Scherling was still relieved to have 15 beds funded by the state.
"We are still in business. We have a contract, so I think we made out fairly
Copyright © 2003, Berkshire Eagle Staff