Advocates' Comments on Proposed MassHealth Eligibility Regulations 8.1.25

Attached are comments by MLRI, HCFA and HLA on proposed amendments to 10 sets of MassHealth regulations. Many of the changes are bringing the regulations up to date to reflect policies amended as far back as 2022 through Eligibility Operations Memos. This includes the amended regulations on Continuous Eligibility for children, people released from incarceration, and people who have been verified as homeless for at least 6 months, as well as expansion of CommonHealth eligibility for people under 65 who no longer need to meet a work requirement or one-time deductible, and a "retirement" benefit for individuals who are now age 65 or older and have been on CommonHealth for at least 10 years. Unfortunately, the proposed amendments do not clarify various policy issues that have come up during the implementation of these initiatives and in some cases propose language that will add to the confusion. 

In  the updates to the estate recovery regulation, the agency only makes housekeeping changes and does not update the regulations to reflect 2024 state legislation reducing the scope of recovery from the estates of MassHealth members who die after August 1, 2024. The proposed amendment to the CommonHealth plus Medicare Savings Program regulations eliminates the 135% FPL income cap but replaces it with vague language that CommonHealth members may be eligible for MSP if they meet the MSP requirements "subject to federal authority." 

Some of the positive proposed changes include regulations restoring 3-months retroactive coverage.  Retroactive coverage going back as far as the 3d month prior to the month of application will be available to anyone found eligible who incurred past medical bills and is eligible during the past period, otherwise coverage will date back to the 1st of the month of application rather than 10 days prior to the date of application. Another positive change is a proposal that all EAEDC recipients qualify for Standard. Currently, EAEDC recipients may receive Standard, CarePlus or Family Assistance depending on age, disability and citizenship or eligible immigration. 

The notice of proposed regulations states that changes are not expected to take effect prior to October 2025. However, the July MTF announced the return to retroactive coverage will take effect in August 12, 2025, and of course many of the changes have already been implemented.