When your health plan goes away

Posted at 1:45 PM on January 6, 2011 by Paul Tosto (4 Comments)
Filed under: Health care

MinnEcon note: For most of us, it's a hassle to change health plans or providers. For people with disabilities and limited incomes it can be a nightmare. Here's a post from MPR's Melody Ng.

What happens when your health care plan stops existing? You hope you're already enrolled in another one -- especially if you're someone with physical disabilities.

Two recent stories from Minnesotans in MPR's Public Insight Network show how changing plans can become a crisis for those who depend on them for medical care and services to live independently.

"Individuals experiencing disability, chronic illness ... rely on [their health plan], sometimes hour-to-hour, day-to-day. These are critically important life support, safety, and security pieces," Lance Hegland of Minneapolis told us.

Hegland, 38, has spinal muscular atrophy. He and 1,275 other Twin Cities adults with physical disabilities had to find new insurance plans after UCare decided to close its UCare Complete program, also known as Minnesota Disability Health Options (MnDHO), as of Dec. 31.

The plan was vital, unique among health care programs, because UCare collaborated with AXIS Healthcare to combine health care coordination with services for independent living. In doing so, MnDHO promoted preventative care, reduced hospitalizations and improved quality of life for people with disabilities.

But it was expensive.

UCare closed the plan reluctantly, concerned about future cuts in federal Medicare payments that "combined with state budget cuts and the uncertainty for future funding made the MnDHO program unsustainable for us to operate with the type of quality programming that we felt was required," said Ghita Worcester, UCare's senior vice president of public affairs and marketing.

UCare helped Hegland and others find alternatives. Worcester said about 1,200 enrollees managed this transition.

Others, though, are still looking for answers.

Johana Schwartz knows she has health insurance. What she doesn't know is who's providing it.

The 29-year-old from Inver Grove Heights chose and submitted paperwork for a new provider on Dec. 10. But she says no one's responded to her application or repeated phone calls.

So, she has no idea if she's now covered under the default plan UCare rolled undecided people into, or if she got the plan she asked for.

She's also unclear on her failing adaptive equipment needed for cerebral and speech disabilities.

Last week, her group home noticed her ankle braces were coming unraveled. She needs a new battery for her speech communications device as well. A few weeks ago, she got the requisite doctor's prescription and ordered the battery, but it wasn't processed in time. Now Schwartz must wait for her new plan to kick in -- whatever plan that is.

She described her situation as, "Scrambling... Crazy enough without holiday business hours interrupting. Franz Kafka's bureaucratic chaos."

Hegland has health insurance under control. His transition to a new plan using AXIS Healthcare was "fairly seamless." But MnDHO's closure was hard on him, too.

"The initial uncertainty and impact of change created tremendous anxiety, fear and frustration for many people in our community," he said.

In a surprising twist, after nearly a year of researching insurance plans and stressing over his future without AXIS (he credits AXIS for motivating him to see his primary care doctor regularly and helping him participate actively in community life), Hegland still has AXIS coordinating his daily care.

His new insurance provider recently contracted AXIS to manage home- and community-based services. In the shuffle, though, Hegland lost the coordinator who's managed his care since 2005.

So he's relieved, but frustrated, too.

"Many of us are right back where we started ... yet we invested a lot of resources over the past year to pull off this transition."

He's not talking about just his own resources; he's concerned about taxpayer money spent and wondering what notes we should be taking to manage health care and other services for aging Baby Boomers.

AXIS executive director Randy Bachman says the Minnesota Disability Health Options model was "ahead of its time," and did a lot of good for many people. He believes with health care reform the model will reemerge.
___________________________________

If you were part of the MnDHO / UCare Complete plan or know someone who was, share some insights and help us add to these stories.

---

Comments (4)

UCARE WILL NO LONGER PAY FOR ME TO WORK OUT AT THE 'FITNESS CENTER' AT 'COURAGE ST. CROIX'...IT IS RIGHT ACROSS THE STREET FROM WHERE I LIVE...PLUS IT HAS THE ADAPTIVE EQUIPMENT I NEED TO WORK OUT...I AM A 'QUAD' & I NEED HELP...BUT THAT IS NO LONGER...THE 'YMCA' IN WOODBURY...WHICH IS NOT CLOSE BY...DOES NOT HAVE ADAPTIVE EQUIPMENT FOR ME TO USE...EXERCISE IS A BENEFIT TO THE DISABLED...IT ALLOWS US TO HEAL FASTER...TO BE MORE INDEPENDENT...TO BE LESS OF A BURDEN ON SOCIETY...BUT THEY DECIDED TO CHANGE THE SYSTEM FOR THE WORSE...FEEL FREE TO CONTACT ME :(

Posted by DENNY PROTHERO | January 6, 2011 2:39 PM

---

As a researcher at Courage Center, I am conducting a study looking at the health effects of cessation of fitness for those individuals who were using Courage Center fitness services before losing MnDHO fitness benefits.

MnDHO fitness services offered to individuals with disabilities allowed them the ability to utilized fintess services in an accessible manner that otherwise would not have occured. Many of the clients utilizing fitness services at Courage Center only did so because of these fitness benefits.

Now, due to the elimination of MnDHO, nearly 200 at the Golden Valley site alone, fitness services will be trimmed down and some fitness specialists may lose their jobs. More importantly, those individuals with disabilities previously using fitness services such as the fitness center, aquatics, massage therapy at Courage Center Golden Valley and St. Croix will see a severe limitation in fitness options.

One option, Medica, requires has a cost-sharing component that is 50/50 so fitness clients seeking to continue at the Courage Center would have to pay 50% of all fitness costs. Their is much confusion among the clients as to how to register and what the exact cost(s) will be.

Another option is going to the YMCA but many clients have reservations because they see YMCA as not only a different facility with new staff but with less accessible equipment available, limiting their workout regimin.

The last option is out-of-pocket. From the 51 people I have signed up for my study so far, nearly all of them know very little about their options or don't have the money to pay for the cost-sharing option. Many will rely on working out at home which will severely limit their fitness regimin.

Posted by Guthrie Byard | January 7, 2011 9:40 AM

---

I've since learned that my presently chosen health plan (i.e. Metropolitan Health Program (MHP)) has not contracted with AXIS yet. Therefore, I'm not back where I thought I was. Subsequently, I have some adjustments to make (i.e. switching over to UCare or Medica) in the next few months. So, this is another example of the tremendous confusion among consumers/families.

Expanded coverage of this issue is available via my Facebook blog post MnDHO/UCare Complete Program Ended 12/31/2010

Posted by Lance Hegland | January 7, 2011 4:16 PM

---

The accessible fitness center at the Courage Center practically drew me to U-CARE, and now to the new plan that I have chosen. I feel like I have to start from scratch if I hope to keep using the fitness center for the purpose of improving the integrity of my transfers. [they are good with me, and I have always benefited from a pt regiment.] In January, the receptionist gave me one quote for participating in my program. Subsequently, I have received e-mail messages from two other individuals with two different quotes for the same service and it doesn't add up at all.
Infer that I am seeking elucidation, Mr. Byard, please feel free to contact me to see if we can resolve this together.
My new plan attracted me with its provision of help with transportation to appointments. A representative of the agency told me over the phone that they are better equipped to transport their ambulatory clients and thus found me just a one way ride. Yesterday my new Axis liaison negated that claim about ambulatory clientele and found a return ride four hours after the appointments conclude. Moral is that whenever I ask a question about the revised system, I get multiple contradictory answers. I'd like to stabilize my routine.

Posted by Johana Schwartz | January 20, 2011 2:47 PM

---

Post a comment

The following HTML tags are allowed in your comments:
+ Bold: <b>Text</b>
+ Italic: <i>Text</i>
+ Link: <a href="http://url" target="_blank">Link</a>
Fields marked with * are required.

Name*:

E-mail Address*:

URL:

Remember personal info?

Comments*:

Comment Preview appears above this form upon pressing the "preview" button. Edit your comment and press "preview" again, until you are satisfied with your comment.

Your comment may not appear on the blog until several minutes after it was submitted.

• E-mail this page
• Print this page
• Tweet this page
• Share this

Services

• Hourly Newscast
• HD Radio
• iPhone App / Mobile
• E-mail newsletters
• RSS feeds
• Podcasts
• Submit your photos
• Videos
• Weather
• Most e-mailed stories