Spotlight on Equity: Testing and Treatment for Everyone, Regardless of Income, Health Insurance Coverage, or Immigration Status

Photo courtesy of Creative Commons.

The novel coronavirus (COVID-19) pandemic exposes disparities in our health care system. It also highlights how interconnected we are to each other. Now, more than ever, as we work to flatten the curve of this epidemic, we need to consider the health and wellbeing of our neighbors who may feel unsafe or unsure about accessing medical care. This includes people who may see care as unaffordable, fear deportation, and those experiencing homelessness.

Through MassHealth, our state’s Medicaid program, Massachusetts provides health insurance to nearly 1.8 million people, including about half the state’s children. In an effort to provide a more inclusive safety net to the most vulnerable among us, Massachusetts has agreed to some emergency provisions to make accessing care more equitable. What are they?

“The pandemic is first and foremost a public health emergency. It’s important that EVERYONE knows how they can access information and care during the COVID-19 outbreak.” — Marie-Frances Rivera

Frequently Asked Questions:

Q1. What happens if someone doesn’t have health insurance and can’t afford a co-pay or other out-of-pocket costs for a test or treatment?

Uninsured patients should seek medical care as needed without fear of costs. In most instances, the health provider will work with the patient to begin a MassHealth application, since MassHealth will cover all testing, diagnosis, treatment for COVID-19, without any cost to the MassHealth member.

What if someone does not have immigration papers, is uninsured, or does not carry private insurance?

Everyone is covered for COVID-19 related care.

Here’s the fine print:[1]

• The Massachusetts “Emergency Medicaid” program, known as MassHealth Limited, is an existing program that provides emergency coverage for low-income persons, regardless of immigration status. The Massachusetts Executive Office of Health and Human Services (EOHHS) has clarified that through these mechanisms, all persons, regardless of immigration status have complete access to testing and treatment during this health emergency, as COVID-19 testing and treatment are considered emergency services.
• EOHHS has stated that eligible hospitals should use what is known as “presumptive eligibility” for people who come to the hospital and self-declare (“attest”) to their eligibility for MassHealth and have a presumed diagnosis of COVID-19. This means that someone who might be able to get their health care costs paid for by the state’s MassHealth program will get enrolled.
• For services not covered under MassHealth, the state’s “Health Safety Net” — which is a fund that is the payor of last resort for health care costs for the uninsured or underinsured — would cover the relevant medical costs.
• According to state guidance, commercial insurers must cover testing and treatment as well, although the federal law falls short of making that explicit requirement.

Q2. Is it safe for immigrants without legal status to seek a COVID-19 test or treatment?

Any person, with or without legal immigration status, should seek medical care when needed. U.S. Immigration and Customs Enforcement (ICE) considers medical facilities and health centers to be “sensitive locations.”[2]

Q3. Will receiving health care during the COVID-19 health care crisis count negatively towards being determined a “public charge”? Could it make it harder for someone to extend their stay or change immigration status?

The U.S. Citizenship and Immigration Services (USCIS) has stated that testing, treatment, or preventive care related to COVID-19 would not count as part of a public charge inadmissibility determination. USCIS states: “The USCIS encourages everyone, regardless of immigration status, who has symptoms that resemble COVID-19 — fever, cough, shortness of breath — to seek necessary medical treatment or preventive services. These services will not negatively affect any future Public Charge analysis, even if the service is provided by one or more publicly-funded benefits (including federally-funded Medicaid).”[3]

Q4. Are there any additional measures the Commonwealth is taking to take care of vulnerable populations?

The state has requested permission from the federal government to allow Massachusetts to expand the nature of services covered by MassHealth. Specifically, Massachusetts is hoping to extend MassHealth coverage to temporary housing for people who are homeless as a result of the emergency, as needed for quarantining, isolating or treating people who are diagnosed with or at high risk of COVID-19 infection. This includes maintenance costs and items to meet basic daily needs such as clothes or toothbrushes. As of April 1, the state is still awaiting a response for this particular approval.

And, on March 26, the state announced that a former Boston Medical Center building in Boston’s South End would be converted into a specialized care center for homeless individuals and families during the COVID-19 outbreak.[4] Similarly, Worcester is preparing its convention center as a location to accommodate similar hospital overflow and to provide needed safe quarantine space for people who are homeless. Unfortunately, these important efforts will only begin to address what we can assume will be a growing need for critical care for our most vulnerable neighbors and friends.[5]

Q5: What does all of this mean moving forward?

Making access to care a priority during this public health crisis is crucial for us all, and Massachusetts could likely expect to see an increase in MassHealth utilization in the coming year. Moreover, this public health crisis goes way beyond health care. Mental health services, family stability, access to affordable food, are all essential for helping our communities stay healthy. It is also critical to focus on the importance of housing stability right now — particularly as we try to flatten the curve of this epidemic by staying home or in quarantine. Now more than ever we can see how housing stability and public health go hand in hand.

Check back for updates as we track the health implications of the Fiscal Year 2021 budget debate.

Nancy Wagman is the Kids Count Director at the Massachusetts Budget and Policy Center, and is also responsible for MassBudget’s Budget Browser. She also covers health care, and federal and other non-tax revenue in the state budget.

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Endnotes:

[1] See the following: https://www.mass.gov/files/documents/2020/03/12/All-288.pdf; https://www.mass.gov/info-details/coronavirus-disease-2019-covid-19-masshealth-provider-faq;https://www.mass.gov/doc/administrative-bulletin-20-09-101-cmr-61300-health-safety-net-eligible-services101-cmr-61400-0/download; https://www.mass.gov/info-details/covid-19-guidance-and-directives#insurance-. The Massachusetts COVID-19 website, Information on the Outbreak of Coronavirus Disease 2019 (COVID-19), states the following: “Insurers must cover COVID-19 related treatment and testing without requiring cost-sharing of any kind — such as co-pays and coinsurance — for testing and treatment.” The federal Families First Coronavirus Response Act signed on March 18, requires health insurers to cover, without any cost sharing, COVID-19 testing but does not go as far as requiring coverage of all related treatment. See https://www.manatt.com/Insights/Newsletters/COVID-19-Update/Summary-of-Key-Healthcare-Provisions-in-the-Second Marketplace and Private Insurance Provisions: Section 6001. Coverage of Testing for COVID-19. Group health plans (including self-insured ERISA plans) and health insurance issuers in the individual and group markets (including grandfathered plans) must cover, without cost sharing, SARS-CoV-2 and COVID-19 testing and items and services related to testing and screening furnished during provider office visits (whether conducted in person or by telehealth), urgent care center visits and emergency room visits that result in testing for COVID-19. The provision is effective on or after the date of enactment of the act and is applicable for the duration of the public health and national emergency period.

[2] According to ICE Guidance on COVID-19, “It is important for the public to know that ICE does not conduct operations at medical facilities, except under extraordinary circumstances. ICE policy directs our officers to avoid making arrests at sensitive locations — to include schools, places of worship, and health care facilities, such as hospitals, doctors’ offices, accredited health clinics, and emergent or urgent care facilities — without prior approval for an exemption, or in exigent circumstances.” See https://www.ice.gov/covid19.

[3] https://www.uscis.gov/greencard/public-charge

[4] https://www.statehousenews.com/?path=cms%2fcontent.aspx&db=briefs&select=2020461 [5] https://www.masslive.com/worcester/2020/03/coronavirus-in-worcester-dcu-center-will-house-up-to-200-additional-beds-in-case-city-hospitals-reach-capacity.html