CAP LIFT URGED TO BROADEN INSURANCE COVERAGE FOR CHILDREN
By Matt Murphy
STATE HOUSE NEWS SERVICE
STATE HOUSE, BOSTON, JULY 22, 2015....When a young girl's family could no longer afford the medical equipment she needed to self-catheterize each day, they decided to try to reuse the equipment and sterilize it themselves.
The girl, who was being treated by a pediatrician at Boston Medical Center, developed a severe infection and had to be hospitalized, according to Health Care for All government affairs director Matt Noyes.
The story, and others like it about low-income children and their families struggling to keep up with medical treatment costs, were relayed to lawmakers Wednesday by backers of a bill to lift the hard caps on benefits for children in the state's Children's Medical Security Plan.
"This is something that could have easily been avoided," Noyes said, saying it would have been cheaper to pay for the girl's catheter equipment than a hospitalization.
The Joint Committee on Health Care Financing heard testimony on the bill and others related to MassHealth and the state Connector Authority on Wednesday.
The CMSP, which covers about 12,000 children in Massachusetts who are just over the income threshold to qualify for Medicaid, comes with a $200 annual cap on prescription drugs, $500 on durable medical supplies and $1,000 on inpatient treatment.
Rep. Elizabeth Malia has filed a bill (H 1009) that would remove the hard caps on benefits and bring the CMSP into MassHealth to be run as a managed care organization. A similar bill passed the Senate last year, but stalled in the House.
Noyes said the bill carries no additional cost because instead of having separate caps on different services, the CMSP would pool the money from the different pots as a capitated program run by MassHealth.
"Severe consequences can result from access barriers in the program," said Andrew Cohen, staff attorney at Health Law Advocates.
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