MassHealth Enrollees Regain Access to Chiropractic

In April, Massachusetts lawmakers took the bold step of making their state the first in the U.S. to approve universal health care legislation, requiring that its residents purchase or otherwise possess some type of health insurance by July 1, 2007. Dynamic Chiropractic recently learned that the sweeping legislation also reinstated a series of benefits, including chiropractic services, for low-income individuals and families enrolled in MassHealth, the state's Medicaid plan, allowing an estimated 600,000 people to regain access to much-needed chiropractic care.¹

"Massachusetts has finally taken a step forward for health care for all," declared Leslie Greenberg, a member of the Lynn Health Task Force and an advocate of the new legislation. "I say, it's about time."²

"Universal health insurance is absolutely wonderful and incredible," added Zoila Torres Feldman, who heads the Framingham Community Health Center, which provides health care services for the poor and uninsured. "The whole country will be watching us."¹

MassHealth is a state-run program that pays for health care for low- and medium-income residents of Massachusetts. It was created in 1995 through the Department of Health and Human Services as part of a federally funded demonstration project, and provides various types of health care coverage for approximately 1 million children and adults.

In 2002, however, interim Gov. Jane Swift implemented a series of cuts to MassHealth, including the complete elimination of chiropractic care for all eligible enrollees.³ An estimated 4,000 adults were receiving chiropractic care through MassHealth at the time the cuts were made.⁴ Other services eliminated from MassHealth included coverage for orthotics, prosthetics, eyeglasses and dentures.

Under the new state law, benefits for more than 600,000 MassHealth enrollees will be expanded to include chiropractic, dental services, vision services, orthotics, prosthetic devices, substance abuse treatment services and tobacco services. Benefits will be available to all adults enrolled in any of the following programs:

• MassHealth Standard
• MassHealth Prenatal
• MassHealth Common Health
• MassHealth Basic
• MassHealth Family Assistance

Services also will be expanded to include up to 40,000 children who either lack health insurance or receive only basic insurance coverage. Other provisions in the legislation will be implemented over the next few years in an effort to expand health care coverage.

In an interview with DC, Dr. Thomas S. Perrault Sr., executive vice president of the Massachusetts Chiropractic Society, provided further details on the history of chiropractic in the MassHealth program, and thanked the state legislature for its role in making chiropractic a mandated service.⁵

"Chiropractic in Massachusetts has been in and out of the Medicaid program because, in the past, it has been an optional service," said Dr. Perrault. "With the passage of this legislation, chiropractic is now included in the Medicaid program as a mandated service.

"In the past, we have been in the program when the governor would put us in by executive order. When that governor would leave, and there would be a financial downturn, they would remove chiropractic as an optional service. That's why we would be in and out of the program.

"The only downside to the program right now is that a medical PCP referral is required in order for a MassHealth enrollee to receive chiropractic treatment. The Society intends to work with the Medicaid department to revise the program guidelines to eliminate the need for a PCP referral. This would make the program much more cost-effective for the state, and easier to administer by all concerned.

"It is more cost-effective for Medicaid recipients to have direct access to chiropractic services. When we eliminate the need for the primary care referral, we save money that way as well. We now have a legislature that will see the benefits of that. These people know the benefits of chiropractic, and they know the economic benefits of it to the state. We're very grateful to the House and Senate for including us in the program, and we're looking forward to being able to help a lot more people, because this program opens up our services to a community that can really benefit from it."

Dr. Perrault also highlighted the efforts of MCS Legislative Chair Steve Saro, a doctor of chiropractic in Dracut, Mass., saying that Saro "was instrumental in bringing about this change."

According to the National Conference of State Legislatures, several states have attempted to provide health care coverage for the uninsured, with varying degrees of success. Hawaii passed a universal access law in 1974 requiring employers to offer health care coverage for employees working 20 hours or more a week; as a result, an estimated 97 percent of the population in Hawaii has some type of health insurance. In 2003, Maine enacted a similar law that combined employer payments with expanded government programs to increase health care coverage significantly. That same year, California enacted a law that required employer contributions, but it was repealed in 2004. And in 2005, Illinois legislators approved a plan that would increase health insurance coverage for children in low-income families.⁶

References

1. Brodkin J. Expanded health care law kicks in. Boston Herald, June 30, 2006.
2. Casey J. New health reform law to reinstate benefits to low-income residents. The Daily Item of Lynn, June 28, 2006.
3. Massachusetts governor deep-sixes chiropractic. Dramatic cuts made to state's Medicaid program. Dynamic Chiropractic, Feb. 10, 2003. www.chiroweb.com/archives/21/04/13.html.
4. Dembner A. $11M Medicaid cut takes effect today. Boston Globe, Jan. 1, 2003.
5. Interview with Thomas S. Perrault Sr., July 18, 2006.
6. Belluck P. Massachusetts set to offer universal health insurance. New York Times, April 4, 2006.