The Online Resource for Massachusetts Poverty Law Advocates

Comment deadline Aug 21 & Chicopee Listening session Aug 16

The Governor & EOHHS remain intent on restricting eligibility and benefits in MassHealth despite the legislature's refusal to add the necessary authorizing legislation to the FY 2018 budget. We expect more legislative activity in September. Meanwhile, EOHHS has released for public comment proposed amendments to the current 1115 demonstration waiver.

Attached & printed below you will find information and links about the proposal and opportunities to weigh-in. MLRI attended the Boston "listening session" and is working on its comments now which we will circulate as soon as we can.

Meanwhile, we urge those of you in W. Mass. to attend the Chicopee event if you can and to speak out about how these proposals will affect your clients and patients and everyone who works with MassHealth members to plan to submit comments. 

We are still trying to get more information about these proposals and would welcome hearing from you about questions and concerns that may not have occurred to us.  Please let us know what you think: vpulos@mlri.org and ncronin@mlri.org

 

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What You Need to Know About the New MassHealth 

Proposed 1115 Amendment

MassHealth is proposing cuts in eligibility and services in FY 2018 and 2019. There is still time to comment. Written comments are due by August 21, 2017. There was a listening session last week in Boston and another is scheduled in Chicopee on August 16, 2017. Please read for more information including MLRI’s top concerns with the proposals.

Information about the proposal:

The proposed Amendment; details on where to submit comments; and additional relevant information are available at: www.mass.gov/hhs/masshealth-innovations/1115waiver.

Written comments due by August 21, 2017:

EOHHS will accept comments on the proposed Amendment through 5pm on August 21, 2017. Written comments may be delivered by email or mail. By email, please send comments to kaela.konefal@state.ma.us and write "Comments for Demonstration Amendment" in the subject line. By mail, please send comments to: Kaela Konefal EOHHS Office of Medicaid, One Ashburton Place, 11th Floor, Boston, MA 02108. Comments must be received by August 21, 2017 in order to be considered.Â

Public hearing "listening session"  in Chicopee August 16, 2017

EOHHS program staff will host two public listening sessions in order to hear public comments on the Request. Stakeholders are invited to review the Request in advance and share with program staff at the listening sessions any input and feedback, or questions for future clarification.

Date: August 16, 2017
Time: 10 a.m. - 2 p.m.
Location: Castle of Knights, 1599 Memorial Drive, Chicopee, MA
Conference Line: 1-888-822-7517 Participant Code: 163 4530#

MLRI's Top Concerns with the 1115 Proposal

1. Proposal to lower MassHealth income limit for non-disabled adults age 21-64  from 133% to 100% of the poverty level resulting in 140,000 people  (100,000 parents and 40,000 childless adults) losing eligibility for MassHealth; presented as a transition to ConnectorCare (2019)

  • ConnectorCare offers good coverage for uninured adults with income up to three times the poverty level but it is not nearly as good as MassHealth for the poor and near poor.
  • Some MassHealth members will not qualify for ConnectorCare because of differences in eligibility rules in the two programs
  • Some MassHealth members will not be able to successfully enroll in ConnectorCare because of more complicated eligibility and enrollment rules in ConnectorCare & deadlines for enrolling
  • Adults who do qualify and do successfully enroll in ConnectorCare will have much higher copayments than MassHealth, fewer benefits and fewer affordable plan choices.

2. Proposal to deny MassHealth to non-disabled adults  21-64 with access tto "affordable" employer sponsored insurance or student health insurance causing from 5,000 to 40,000 adults with income under 133% of poverty to lose coverage in 2018

  • For the poor and near poor in a state with high housing costs like MA, no more than nominal copayments of MassHealth are affordable.  Few will have access to any commercial insurance much less truly affordable insurance.
  • MassHealth proposes to define "affordable" to include monthly premiums, deductibles and other cost sharing that will not be truly affordable to the poor and near poor.
  • Adults denied MassHealth will also lose Premium Assistance to help with the costs of employer-sponsored or student health insurance.

3. Other eligibility or benefit restrictions for non-disabled adults

  • Moving 230,000 nondisabled parents 19-64 from MassHealth Standard to CarePlus in 2019
  • Cutting off MassHealth Limited after 90 days for lawfully present immigrants who are found eligible for ConnectorCare but fail to enroll by the deadline (2018)
  • For adults with MassHealth secondary to other coverage, no longer providing MassHealth benefits not covered in the primary coverage (with unspecified exceptions)
  • For students enrolled in a Student Health Plan with premium assistance, no longer reimbursing for the deductibles and copays for services from non-MassHealth providers.

4. Benefit and network restrictions affecting all kinds of MassHealth members

  • Denying coverage for drugs that MassHealth would otherwise be required to cover under federal Medicaid rules  (going to a “closed drug formulary” with some kind of exception process) and limiting the number of pharmacies available to provide certain specialty drugs
  • Narrowing the network of medical providers in the Primary Care Clinician Plan (currently all MassHealth participating medical providers are included in the PCC Plan including hospitals like Boston Children’s Hospital and Mass. General Hospital that are not included in many of the MassHealth Managed Care Organizations).

For a more detailed description of concerns with an earlier version of these proposals, see the comments to the conference committee of MLRI and others posted on

https://www.masslegalservices.org/content/fact-sheet-letters-fy-18-conference-committee-last-minute-masshealth-reform-proposals


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