18. How does ConnectorCare work with MassHealth Limited and the Health Safety Net?
The Health Safety Net. The Health Safety Net (HSN) is available to state residents with income that does not exceed 300% FPL using the MassHealth MAGI and income verification rules. Acute care hospitals and community health centers bill HSN for services to HSN-eligible individuals who are uninsured or underinsured. However, if HSN-eligible individuals are also found eligible for ConnectorCare, it will limit their HSN eligibility period. Such individuals will be eligible for HSN from the “medical coverage date” (10 days prior to the date of application for those under 65) and for up to 90 days after the date they are found eligible for HSN. See, MassHealth Eligibility Operations Memo 18-02 (July 1, 2018). After that time elapses, or they enroll in ConnectorCare, whichever comes first, they will retain HSN only for adult dental services not covered in ConnectorCare. An individual who fails to enroll in ConnectorCare when eligible to do so will later lose all HSN benefits except for dental.
MassHealth Limited. MassHealth Limited only covers emergency services and doesn’t count as government sponsored MEC. Certain lawfully present noncitizens may be eligible for both MassHealth Limited and ConnectorCare at the same time. These individuals will be non-citizens whose MassHealth MAGI income is at or under 133% FPL and who are lawfully present for purposes of the Health Connector but do not meet MassHealth immigrant eligibility rules for MassHealth Standard or CarePlus.
When individuals are found eligible for ConnectorCare and Limited and receive an approval notice from MassHealth and a MassHealth card, they may easily be confused about their coverage. They may not understand that Limited covers only emergencies, and fail to take further action to enroll in ConnectorCare during open enrollment. Language issues may contribute to the confusion. In such situations, it may be possible to obtain a special enrollment period or a waiver from the Office of Patient Protections to enable the individual to enroll in ConnectorCare.
Despite the confusion, there are some advantages to being found eligible for ConnectorCare and Limited: An infant born to a mother eligible for Limited will be automatically enrolled in MassHealth Standard effective on the date of birth; Limited eligibility will be retroactive 10 days prior to the date of application for those under 65 or up to 3 months retroactive from the month of application for those 65 or older, and, for those who do not enroll in ConnectorCare, Limited will be available to cover emergency services even after full Health Safety Net coverage has expired.
101 CMR 613.04(6)(a)(2) (HSN primary and secondary) and (7) (HSN eligibility period) and 613.02 (definition of medical coverage date); MassHealth Eligibility Operations Memo 18-02 (July 1, 2018). 130 CMR 506.006 and 519.009 (Limited eligibility), 450.105(F) (Limited coverage) and 505.002(B)(1)(b) (Newborns).