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December MassHealth Update

MassHealth Initiatives to Control Costs

MassHealth enrollment is at 1.9 million and continues to grow. MassHealth announced a series of initiatives designed to prune the roles of people who may not be eligible.  Unfortunately, the pruning is likely to also affect individuals who remain eligible but missed paperwork deadlines or got caught up in systems defects. Be on the lookout for clients and patients coming in with Notices terminating benefits or requesting information by a deadline.  Remember MassHealth beneficiaries can stop an erroneous termination if they appeal before the date scheduled for termination.

  1. 24,000 termination notices mailed Dec 16, terminating benefits on Dec 30 for failure to reply to request for information about access to employer-sponsored insurance. 
  2. Dec. 16, 2016 system change to prevent individuals who already have one on-line application from initiating a new application. This will primarily affect on-line applicants more of whom will have to call MassHealth to identify and correct problems with an application rather than starting over with a new application.
  3. About 30,000 individuals who have determinations for MassHealth and more recent duplicate determinations for ConnectorCare who have not enrolled in ConnectorCare, will be receiving notices terminating their MassHealth benefits.
  4. About 6,000 individuals who received a MassHealth termination notice but remained open on a duplicate account will be terminated.
  5. About 18,000 individuals who were protected from termination due to system defects that have now been corrected will be sent a notice requiring them to renew their coverage by a deadline to remain eligible.
  6. Early in 2017, MassHealth will resume periodic data matches with IRS, DOR and SSA to look for unreported changes in income between annual renewals.
  7. A vendor will be checking the bank balances of about 93,000 community seniors under a new electronic asset verification system.

MassHealth Customer Service Slow Down

MassHealth staffing in 2015-2016 had been increased to handle the transition from the legacy computer system, but that extra staff help has been cut by 2/3. On top of that, MassHealth has experienced a number of vacancies from workers taking up the recent early retirement option.  As a result processing times for paper applications are taking longer and telephone wait times are up.

Managed Care Developments - First fixed enrollment period begins Jan 1, 2017

The first fixed enrollment period begins January 1, 2017 for people who were enrolled in mandatory managed care on October 1, 2016. MCO members who want to change plans will have to call MassHealth & show one of 11 permissible reasons to change plans during their fixed enrollment periods. Denial of a request to change plans is appealable. New applicants will have 90 days from managed care enrollment to freely change plans before they are locked in for the year.More information is posted here,

Connector Open Enrollment ends Jan. 31, 2017

Limited time for people without other health coverage in 2017 to get individual coverage. 

This includes individuals found eligible for ConnectorCare who did not enroll in 2016; they now have a new chance to enroll in ConnectorCare for 2017.

Limited time for those in the Connector to change plans.

In 2017 some ConnectorCare MCOs including Neighborhood Health Plan will be charging much higher premiums than they did in 2016, their members have to change MCOs during Open Enrollment to avoid premium increases for 2017 coverage. Not sure if it's ConnectorCare NHP or MassHealth NHP? Look for ConnectorCare & Connector logo on the NHP card. The premium increase only applies to ConnectorCare NOT MassHealth.

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