For years now, I’ve been volunteering with an organization called SHINE (Serving the Health Information Needs of Everyone). SHINE is the Massachusetts implementation of the nationwide SHIP (State Health Insurance Assistance Programs). SHIPs provide free, personalized, unbiased advice to Medicare beneficiaries about their health care coverage options.
Every state implements SHIP a little differently. In Massachusetts, SHINE Counselors complete 50 hours of rigorous training, followed by a test administered by the Massachusetts Executive Office of Elder Affairs. After this, the counselors must attend monthly meetings to stay up-to-date with policy and regulatory changes and take an annual recertification exam. I’ve been a state certified SHINE Counselor since June 2015 and just passed my recertification exam.
The material is not easy. For example, did you know:
- Massachusetts has a program called CommonHealth available for people with disabilities. It offers the same benefits as MassHealth (i.e. Medicaid), but it’s not the same program. If you’re over 65, you must work 40 paid hours per month in order to participate, but this is not the case if you’re under 65. You can get kicked out of the program and lose your health coverage if you turn 65 without realizing this.
- If you have a privately administered Medicare Advantage or Medicare D plan, your doctor/hospital/pharmacy can stop participating with the plan’s network in the middle of the plan year, leaving you without access to your preferred medical providers until open enrollment in October (when you can select a new plan to take effect in January).
- Medicare will not reimburse hospitals for the first 3 pints of blood you receive. You either have to give it back, have someone give it back on your behalf, or pay for it.
While the program is staffed largely by volunteers, it still costs money to administer. In total, the 54 state and territory SHIP programs nationwide receive $52.1 million/year of federal funds. That’s less than $1 million per program per year. Some states provide supplemental funding to their program; Massachusetts does not. The Massachusetts SHINE program only has these federal funds to serve over 100,000 Medicare beneficiaries.
But wait - there’s more. The Senate Appropriations Committee last month nearly unanimously voted to completely defund SHIP in the FY17 federal budget through the Labor, HHS, Education Appropriations Bill. This still needs to get through the House of Representatives before it passes, but it doesn’t look good.
The thing is, the need for SHIPs is largely a failure of markets and the government. People turning 65 who are new to Medicare turn to SHINE when the Social Security Office can’t answer their questions or can’t give them an appointment (employees of the SSA will often refer over their complex cases). Major medical centers all have financial services offices staffed with employees who are paid to help low-income patients apply for Medicaid and other assistance programs, among other things, but they often miss the people who don’t know to ask for help. Medicare D is structured in such a way that elderly people in cognitive decline need to pick out a new plan every year to make sure their necessary prescription drugs are still covered -- which means that they need to call SHINE to operate the internet for them each year because there is no government-administered Part D plan that they can trust to be reliable from year to year like there is for Medicare A and B.
An army of unpaid retirees, students, and housewives is not a sustainable solution, nor should it be. Charity and non-profit work is virtuous, but it is not a strong foundation for America’s health care industry. If people with complex situations can just be handed off to volunteers without resources, what are we paying for? If our health care system doesn’t serve all of us, it doesn’t serve any of us. If it only serves us when we are young and healthy, and can turn to dust when we suddenly have a permanently cognitively debilitating seizure; urgently need an anti-clotting drug that is not on our plan’s formulary; or our trusted medical specialist stops accepting our insurance six months before we can buy new coverage at open enrollment - if it only serves us when our health needs are simple, what do we really have?
In all, SHIP does real good and helps real, vulnerable people with nowhere else to turn. If it loses its federal funding, even if the program continues without it, people will be hurt. Yet the program remains a symptom of a fragmented, expensive health care system that often harms the people most in need of its help.
