Thousands of legal immigrants facing steep cuts in state-subsidized health care will keep core medical services such as routine doctor visits and hospital treatment under a plan unveiled yesterday by Governor Deval Patrick.
The initiative, which also includes prescription drugs, mental health services, and emergency care, salvages coverage for 31,000 immigrants considered to be especially vulnerable because of their low income and their status as refugees who have lived in the United States less than five years.
But it comes at a price, for both patients and the providers of care – and it was greeted with an amalgam of relief and concern from advocates for immigrants, and with skepticism from competitors of the insurer selected to cover this group. The new plan will no longer cover dental, vision, hospice, or skilled nursing services, and, in some cases, it will boost medication and treatment co-payments for patients. And the insurer, a subsidiary of a Missouri company, will probably lose money on the deal.
The immigrants’ coverage under the state’s Commonwealth Care plan, the centerpiece of the state’s landmark 2006 health care overhaul, expired yesterday, after the Legislature initially eliminated $130 million for their care to help balance the state’s sagging budget. Ultimately, legislators restored $40 million, but it was uncertain until yesterday whether that money would be enough to provide more than emergency care and other limited services.
The deal announced yesterday illustrates how need and opportunity can align: The state needed someone willing to cover the immigrants at roughly one-third of what it had been spending, and the insurer, new to the state, saw an opportunity to gain a toehold in a lucrative market. The company, CeltiCare Health Plan of Massachusetts, is making its gambit aided by two powerhouses in the Boston market, Caritas Christi Health Care and Partners HealthCare.
“They’re losing money on this big time,’’ Dr. JudyAnn Bigby, secretary of health and human services, said last night in an interview. “But they’re very committed to making sure this population of legal, tax-paying immigrants gets a fair shake.’’
The immigrants must wait at least a month before their coverage begins, reflecting the time necessary for CeltiCare to expand its network of doctors and hospitals and not an effort to save money, Patrick said in a conference call with reporters. Coverage is expected to start Oct. 1 for 13,000 patients in Greater Boston and to extend statewide by Dec. 1.
In the meantime, the legal immigrants will be able to get emergency care through the state’s safety net program for impoverished patients; some of them may be eligible for MassHealth, the insurance program for the poor underwritten by the federal and state governments.
“It’s been a daunting challenge to preserve the promise of health care reform for this constituency,’’ Patrick said.
While expressing relief that an agreement had been reached, advocates for immigrants and consumers also expressed deep worries about the symbolism of offering a less-generous plan for immigrants and a more-sweeping set of services for other poor patients. “We don’t believe in creating a second layer of coverage because of immigration status,’’ said Eva A. Millona, executive director of the Massachusetts Immigrant and Refugee Advocacy Coalition. “And I’m sure it’s not a principle of this administration, either, but it’s because of the current financial crisis.’’
One of the state’s most powerful voices for medical consumers, Health Care for All, warned that as patients shift from their existing insurer to the new plan, they may sacrifice relationships they have developed with doctors, clinics, and hospitals.
“How well does the transition occur? Can it happen smoothly? How do we best keep continuity of care?’’ said Lindsey Tucker, health reform policy manager at Health Care for All. “We’ve been getting calls from people who are pregnant and delivering in September or have a scheduled surgery for this Friday.’’
Richard Lynch, chief executive officer of CeltiCare, pledged in an interview that the company would be “very sensitive to issues associated with patient care and transition of care.’’ He acknowledged that the financial terms of the deal present a “challenge’’ to the company, which entered the Massachusetts market earlier in the summer.
“This is an opportunity for us to show the state we are committed to Massachusetts and to the people,’’ Lynch said. But an opportunity for CeltiCare means a loss of business for the four insurers that had been covering the immigrants, and that has angered the trade association representing those companies.
Dr. Marylou Buyse, president of the Massachusetts Association of Health Plans, complained that the previous insurers of the immigrants were not given sufficient opportunity to craft new coverage plans.
“We’re concerned the state couldn’t reach a solution with the original Commonwealth Care plans and instead reached agreement with one entity that’s new . . . and untested in the market,’’ Buyse said.
Bigby said the state had made its requirements clear and that it pursued a deal with the insurer willing to provide the most comprehensive care at the $40 million price tag.
Caritas, which includes a network of hospitals and doctors in Eastern Massachusetts, and Partners, anchored by Massachusetts General and Brigham and Women’s hospitals, will be key providers of physicians and hospital services through CeltiCare. Additionally, Partners has pledged $5 million toward caring for the immigrants.
“We thought it was important to make that $5 million commitment as an additional building block to making sure this population would have continued coverage,’’ said Matt Fishman, Partners’ vice president for community health.
Stephen Smith can be reached at stsmith@globe.com.
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