CCA OneCare: Letter from Health Law Advocates on behalf of DPC to DOI/AGO/Gov
Dear Governor Healey, Attorney General Campbell and Commissioner Caljouw,
Health Law Advocates (HLA) and Hagens Berman Sobol Shapiro LLP represent the Disability Policy Consortium (DPC). DPC was founded in 1996 by leaders in the disability community in response to state initiatives that would have harmed the disability community. These policy efforts were ultimately thwarted. True to its mission, DPC is a statewide cross-disability rights and advocacy organization that serves as a vigilant watchdog for data and activities that could undermine access to services for people with disabilities in Massachusetts. With the credo "About Us, By Us," DPC seeks to redefine the role of government as it affects the disability community, and to ensure that when decisions are made about people with disabilities, people with disabilities play a lead role in making them.
We write on behalf of DPC in connection with Commonwealth Care Alliance (CCA), a Massachusetts non-profit integrated payer and care management system. CCA is a bedrock organization in our community serving people with disabilities. It finances and coordinates health care and wraparound services for approximately 45,000 disabled Massachusetts residents eligible for both Medicaid and Medicare. Its pioneering person-centered, team-based model of care was developed to be member-directed and tailored to members’ needs to optimize health outcomes.
It is now urgent for the Division of Insurance (DOI) and the Attorney General’s Office (AGO) to act to protect CCA’s members. In recent weeks, we wrote to and met with the Attorney General’s Office urging its team to proactively protect the interests of CCA’s members as rumors circulated about an acquisition of CCA. Now that we have heard that no acquisition of CCA is imminent, that its financial position may be unsound, and that its members are at increasing risk, we believe the DOI must pursue, by and through the AGO, a temporary receivership of CCA pursuant to Chapter 176G, Section 20 and Chapter 175, Section 180B of the Massachusetts General Laws.
The aim of such a receivership should be the rehabilitation of CCA because it is absolutely essential to ensure that CCA provides access to care for its members through its unique home-based and dignity driven care model designed in collaboration with the disability community. HLA, which has nearly 30 years of experience representing marginalized populations threatened with loss or denial of life-saving health care, authored CCA’s original legal framework. HLA set CCA up as a non-profit membership organization with Health Care For All and the Boston Center for Independent Living (BCIL) as its governing organizational members. DPC along with BCIL played a pivotal role working with the then leadership of CCA in transitioning the plan to One Care while remaining true to its model of care. Maintaining this model of care was foundational to securing the support of the disability community in the creation of One Care. DPC was and remains a leader in working with MassHealth and the Center for Medicare & Medicaid Services in shaping One Care and advocating for members’ rights with CCA leadership. The originating structure and ongoing relationship between CCA and the disability community shows CCA is not just an ordinary non-profit health plan, but in fact, it is a community trust.
In addition to being a community trust, according to its 2021 Annual Report, CCA had approximately 30,000+ One Care members and approximately 14,000+ Senior Care Options (SCO) members. That report also states 72.6% of CCA members have a physical or behavioral health disability, 25.1% have a substance use disorder, and 7.5% have a complex physical disability. Despite One Care’s potential growth from three plans to seven plans in 2026, CCA will remain the plan with the largest overall membership and the plan with the largest population of persons with complex physical or behavioral health disabilities. If CCA is dissolved there is no single plan or plans that can absorb the CCA population. This will leave an unknown percentage of CCA members searching for care in MassHealth’s Fee For Service system. This is not an acceptable option given a high percentage of people in CCA with complex needs. Allowing for the dissolution of CCA is the last option the state should consider.
A temporary receivership is the best option at this time to ensure CCA members can continue to enjoy access to the health care they need now and in the long-term. Moving CCA members into other health plans denies them the health care delivery model that they need, especially members with complex health conditions, and that CCA is uniquely positioned to provide in the future. Given its apparent current trajectory, permitting CCA to continue operating without direct state oversight is insufficient in light of the clear presence of necessitating factors that allow for a temporary receivership and the gravity of the situation our community is presented with.
As you are aware, there is precedent for a successful temporary receivership of a key Massachusetts health insurer, Harvard Pilgrim Health Care (HPHC). At the start of 2000, when HPHC faced a dire financial picture, the DOI wisely stepped in to stabilize the health plan for the benefit of its membership and the public interest. In May of 2000, the Supreme Judicial Court approved a final rehabilitation plan that positioned HPHC to serve its members going forward without state oversight. CCA’s members deserve no less decisive action at this time.
We also view a temporary receivership of CCA as a critical step to avoid an untimely disruption in the Commonwealth’s health care infrastructure. Whereas we are only a few months removed from the exit of one of our largest hospital system operators under a cloud of bankruptcy, it is imperative to strengthen the stability of our health care system and preserve the nation-leading health care it delivers to our residents.
Thank you for your consideration of our client’s position. We ask that your offices follow up with HLA’s Executive Director Matt Selig to discuss this matter further. He may be reached by telephone at 617-275-2986 or by email at selig@hla-inc.org.
Sincerely,
Matt Selig, Esq. /s/ Thomas M. Sobol, Esq.
Executive Director Partner, Executive Committee
Health Law Advocates Hagens Berman Sobol Shapiro LLP