The LO did preliminary research on the issue of payment for medical services. While payment was not an original LO research question for this year, the LO determined that it could be a concern for those who will eventually draft legislation and deal proactively with legislators' concerns. In addition, payment often is a constraint when dealing with health care. Therefore, it is important to learn how services are currently paid for, which may lead to ideas on how to propose expanded legislation with payment options.
Preliminary payment research revealed that the state of health insurance in Massachusetts leaves room for interpretation when providing coverage for residents under the age of 18. It seems possible that through the use of an expanded Mature Minor Rule, general health care for homeless youths could be financially covered through existing state and federally-subsidized health insurance. The children's Health Insurance Program (CHIP or Title XXI of the Social Security Act), passed in August 1997, is a federal program that provides $24 billion in matching funds to states over five years for their health insurance expansion efforts. Mass. Ann. Laws ch. 118E, §9A (1997), is the formal authorization of the CHIP expansion and extended MassHealth (Massachusetts Medicaid) coverage to children who live in families below 200% of the federal poverty level. Coverage includes eye examinations, hearing tests, mental health, and dental care. The Department of Medical Assistance administers MassHealth.
It is unclear if homeless youth are able to obtain MassHealth coverage independent of their family. Children under 19 are covered, but it is not specified if they must be part of a family. Additionally, CommonHealth provides health care benefits to children under 19 who do not qualify under MassHealth standards. Further research should investigate what provisions of MassHealth children may not qualify for that CommonHealth may alternatively provide. Furthermore, Special Kids/Special Care is a Massachusetts health care program for minors in foster care. Care is provided by a nurse practitioner from Neighborhood Health Plan (NHP) who works with a DSS case manager, DSS family resource worker, foster family, and primary care physician. While homeless youths are not part of the DSS system, this health plan could potentially be modified to form a compromise wherein youths could obtain generalized medical care, and any abuse of the system could be kept in check as a function of state oversight.
In addition, interviews with youth caseworkers could determine the practical current application of any or all of these options. With this information, next year's LO could further research payment for medical care obtained by homeless youth, or, in contrast, it may not be a direction in which JRI wishes its resources to be spent.