| Cape Cod Times
NEED TO FIND OUT HOW MUCH STATE MONEY GOSNOLD GETS BEYOND MASSHEALTH REIMBURSEMENTS
DID GOSNOLD CHANGE IT’S POLICY – DO THEY HAVE A CENSUS THEY CAN SHARE
The state Department of Public Health found that a drug detox facility in Falmouth has denied MassHealth clients open beds, preferring instead to hold them for clients with private health insurance.
A complaint filed Aug. 10 that was substantiated claimed that staff at the treatment center denied open beds to clients who had Massachusetts Medicaid health insurance, also known as MassHealth.
According to the complaint, which was obtained by the Times through a public records request, “clients with Masshealth are being denied access when beds are open as they prefer to hold them for commercial insurance.”
Kevin Ralph, chief development and external relations officer for Gosnold, said in response to the complaint that BSAS? asked that Gosnold and that it formally train employees on how to uniformly manage the admissions process.
Those steps were taken last fall, and BSAS was satisfied with it as a corrective action, Ralph said.
“We are fully compliant with BSAS regulations and, on a related note, our Medicaid/MassHealth admissions to the Treatment Center by far exceed those who are admitted with commercial insurance,” he said in an email. Does DPH agree??
Ralph said Gosnold staff reach out to patients on the waitlist when a bed becomes available for treatment, and that those admitted to Gosnold are predominantly insured by MassHealth.
MassHealth provides coverage to more than 1.8 million people, which represents more than a quarter of Massachusetts residents, according to Commonwealth Medicine. MassHealth covers a significant number of low-income works, including about 100,000 sales and food services workers.
But former Gosnold employees and patients say it has been a practice for years at at the substance rehabilitation center to give lower priority to on MassHealth.
Meaghan Mort, a former employee, said she was informed by admissions staff to try to fill beds with patients with private insurance, and at the end of the day if there any empty beds left, to reach out to MassHealth patients on the list.
“It’s wildly unethical,” she said.
Another former employee who recently left Gosnold, who asked that her name be withheld because she feared retaliation, also noted the insurance inequity. They said they have seen instances where MassHealth patients will call twice a day for two weeks and be told that there are no beds. But a patient with Blue Cross Blue Shield, for example, would get a bed that day, they said.
Jade Weldon, a Cotuit resident who has been sober for six years, was treated at Gosnold a couple of times.
“It’s almost like they were selling beds,” he said. “If you didn’t have private pay insurance, you were not going to get a bed.”
Weldon said most people wanting treatment went to Boston or facilities off-Cape because they could not find a bed in their own community, which also puts an added burden on facilities in Boston.
Weldon had stayed in a bedroom at the Miller House, an affiliate of Gosnold. Staff had taken him out of the bedroom and put him in a less desirable one with multiple people because someone with private pay insurance was coming and staff wanted to give that person a nicer room, Weldon said.
About five years ago Weldon had pushed to get some programs available on the Cape. He and others started a nonprofit organization called Addiction Services and Placement to help people find treatment. He worked with a state representative who wanted to align the program with Gosnold and another off-Cape company, Weldon said, and it soon became clear it was going to be another situation that prioritized people with private health insurance.
“I know that drug addiction affects everybody, but it really takes its toll on people from lower incomes,” he said. “The majority of drug addicts are going to have state insurance.”
And to have them pushed aside and told to call back while staff fill beds with private-pay insurers is “incredibly dangerous,” Weldon said.
Kevin Mikolazyk is executive director of the Herren Project, a nonprofit organization that provides free resources and support for the treatment, recovery and prevention of people struggling with substance use. He said the Herren Project has been referring clients to Gosnold for almost 10 years and has never had anyone turned away because of their insurance.
“At times we do have clients who do need to wait a day or two to get in,” he said in an email, “but this has happened to both clients with MassHealth/Medicaid and clients with commercial insurance.”
Health care providers look at their payer mix of insurances, Mikolazyk said. He thinks the bigger problem is that reimbursement rates from MassHealth and Medicaid do not cover the cost to provide services.
Medicaid reimbursement rates tend to be lower than private insurance, said Timothy Creedon, a research scientist in the Health Equity Research Lab at Cambridge Health Alliance, whose research focuses on how insurance coverage and other social factors interact to facilitate or prevent access to care.
“On one hand you can understand these facilities are trying to provide their service and be able to operate and pay their employees and attract high quality certified professionals,” he said. “But if you have a case where it’s a provider that is accepting both coverage??? but then holding out, that’s a challenge.”
It is not unheard of for health care organizations to favor patients with private insurance over patients with Medicare and Medicaid. In 2017, Mayo Clinic CEO John Noseworthy told employees that it will prioritize patients with private insurance over those with Medicare or Medicaid so that they could be “financially strong at the end of the year,” according to published reports.
Studies have also confirmed that people with Medicaid may receive unequal medical treatment, and that many physicians refuse to accept new Medicaid patients.
A 2018 study published in the Journal of the American Heart Association, for example, found that treatment and health outcomes vary between patients who are Medicaid-insured, uninsured and privately insured, with Medicaid-insured patients most disproportionately affected.
MassHealth and Medicaid programs serve a disproportionate amount of people with mental health and addiction treatment needs, compared to private insurance companies, Creedon said. They serve more vulnerable populations who often have greater health care needs, but have access to fewer resources to have those needs met.
The Affordable Care Act, which became law in 2010, requires health insurance companies to cover behavioral health on par with general medical services, Creedon said. But there is no law that says private insurance and Medicaid need to have the same reimbursement rates.
Medicaid programs also serve disproportionately non-white, racially ethnic minority groups, he said.
“So when treatment facilities make decisions to preferentially seek people of private health insurance instead of MassHealth, in some cases that can even be a form of structural racism,” Creedon said.
One solution to this problem, he said, is to offer better reimbursement rates that will lead more health care providers to accept MassHealth and Medicaid. With MassHealth, it is more complicated because it is a joint federal and state program, so it would require more state or federal dollars to get better reimbursement, he said.
Weldon is happy that the issue is being examined, he said.
“It’s criminal, in my opinion,” Weldon said.
Contact Jessica Hill at [email protected]. Follow her on Twitter: @jess_hillyeah.
