A mural at the Somerville campus of the Cambridge Health Alliance. (Photo: Marc Levy)

Somerville school enrollment workers say cutbacks and policy changes at the Cambridge Health Alliance have made it more difficult for newcomers such as migrants and refugees to get help obtaining subsidized insurance, such as MassHealth. Newly arrived families are also waiting longer for doctors’ appointments, they say.

Elizabeth Quaratiello, director of school health services, and health coordinator Kayla Centeio brought their concerns to CHA’s advisory committee on population health on March 26. They said families and individuals, including unaccompanied youths, now must make an appointment to get insurance help from the Alliance, where previously people could walk into a hospital and some clinics for assistance on the spot.

Centeio said the wait for an insurance enrollment appointment could stretch for three weeks, with another week for a MassHealth card. Since the pandemic, the Alliance won’t let anyone make a doctor’s appointment unless they have insurance, and an appointment with a pediatrician can take three to four months, Centeio and Quaratiello said in a later statement. “For many of our families this creates significant barriers to and delays in enrolling in school,” they said.

“These families are unfamiliar with our health care system, often speak little or no English and need help complying with school health regulations,” they said. If the newcomers have incomplete health records, the school enrollment counselors “help them obtain insurance so they can establish a ‘medical home’ and get an ongoing source of health care.”

CHA is a “safety net” hospital with high numbers of low-income and uninsured patients “and their mission is to provide health services to underserved communities,” Quaratiello and Centeio said. “They have been a trusted provider of health care for many years and a valued member of our community.”

But “it has become increasingly difficult for our families to access CHA services” over the past two years, they said.

At the meeting, CHA chief financial officer Jill Batty confirmed that the Alliance no longer offers walk-in financial counseling services.”Unfortunately we had to streamline that based on people getting care at the moment,” Batty said. “It is a challenge.”

Centeio and Quaratiello said at least 60 families in the past year have faced the delays. “CHA has told us that they just don’t have the staff to assist, and so refer families to nonprofit organizations such as Health Care for All,” they said.

Three weeks to three days

CHA spokesperson David Cecere said the Alliance offers in-person application help at its Everett and Cambridge hospitals and at the Somerville campus, and is booking appointments “three days out – we are generally able to accommodate people in the same week they contact us to make an appointment.” People can also call (617) 665-1100 weekdays from 8:30 a.m. to 5 p.m., he said.

If people bring the required documents to their appointment they “will leave a financial access appointment knowing they have coverage with MassHealth, and we will immediately begin to work with them to establish care with a CHA provider,” he said. As for the wait for a doctor’s appointment, “access to primary care is a nationwide challenge.”

Cecere also mentioned Health Care for All as a resource in a response to questions from Cambridge Day. The organization’s website says it coordinates a network of certified MassHealth application counselors and operates a telephone help line. MassHealth itself lists a directory of application counselors on its website, though it says many of the help sites require an appointment. CHA is on the MassHealth list.

“Given the unprecedented demand for health insurance enrollment, CHA encourages multiple avenues for MassHealth enrollment assistance,” Cecere said.

CHA points families elsewhere

At the March 26 committee meeting, several members suggested that the Somerville schools workers refer newly arrived families to other agencies that provide walk-in MassHealth application help, such as the welcome centers the state established for migrant families. That could present a barrier, Centeio and Quaratiello said. “These families require services that are local in Somerville, as they may lack the resources to travel to and from welcome centers in other communities,” Centeio said.

Beside that, it would be best to provide insurance support “within the CHA system, because it is hard to decipher the specific insurance products that CHA can accept, which creates a further barrier to care,” Centeio and Quaratiello said.

Cambridge school enrollment workers haven’t seen the same problems cited in Somerville, Cambridge Public Health Department spokesperson Dawn Baxter said. “We are finding that many of the new families have already enrolled in MassHealth. We are referring those who need to enroll to one of the designated enrollment sites that have open walk-in hours,” Baxter said. The Cambridge health department includes school nurses and is operated by CHA.

Quaratiello and Centeio said they “remain hopeful that continued dialogue and collaboration with CHA will enable us to streamline these processes and ensure that all students have access to essential local health care services.”