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Health Update -June 3, 2020

June 3, 2020 Health Updates

Three new developments that will reduce medical debt: 1. Retroactive eligibility, 2. Protecting more Medicare beneficiaries from balance billing 3. Fewer people charged copays.  Updates on 4. Student Health Plan Premium Assistance ending but students protected from losing MassHealth 5. IRS Debit Cards  and  6. MassHealth’s Summary of its Eligibility Flexibilities during COVID 19

1.      Retroactive Eligibility (Up to 90 Days) for Members Under the Age of 65


In a further response to COVID 19 MassHealth announced that MassHealth members who applied on or after March 1, 2020 can request that their start date be retroactive up to 90 days. Eligibility may be requested as early as the first day of the third calendar month before the month of application, but no earlier than March 1, 2020. The MassHealth Training Forum provides more information here.


A little history….Federal Medicaid requires up to 90 days of coverage retroactive from the date of application. This enables low income people to avoid medical debt they may have incurred before being able to complete an application. However, in Massachusetts we switched to 10 days of retroactive coverage for most people under age 65 under the terms of the first 1115 demonstration back in 1997. It was only people 65 and older or needing nursing home care who retained 90 days retroactive coverage. 


Please keep track of patients and clients who benefit from this 90 day retroactive coverage period during the COVID-19 emergency. This kind of information will be important if we ever want to regain 90 days retroactive coverage as a permanent feature of the Medicaid program as it is in almost all other states! Please send us your stories: and


2.      About 9000 Medicare beneficiaries (non-duals) with income between 100-130% FPL who were not upgraded from the Buy-In to the Senior Buy-In program will soon have their benefits corrected.  


On January 1, 2020 MassHealth increased the income limits for the Medicare Savings Programs.  However, due to a computer programming error, individuals with income between 100-130% FPL who were now eligible for both payment of their Medicare Part B premium and protection from other cost-sharing in Medicare Parts A and B, only received payment of the Medicare Part B premium.  MassHealth reports that it will take about two weeks to identify and correct this mistake which will benefit at least 9000 affected individuals as well as new applicants. We expect the correction to be effective Jan. 1, 2020. The added benefit means that Medicare providers are not allowed to bill these Medicare beneficiaries for Medicare Parts A & B deductibles, copayments and co-insurance incurred after Jan 1. MassHealth calls this program the Senior Buy-In but it is available to eligible Medicare beneficiaries regardless of age. Federal Medicaid calls this program the Qualified Medicare Beneficiary program (QMB). The federal Medicare-Medicaid agency (CMS)  has more information about the cost sharing protections for QMBs  here  

Medicare beneficiaries with questions about this can contact the SHINE program or advocates at the Medicare Advocacy projects

3.      New cost-sharing protections take effect July 1, 2020 

MassHealth has released more information about an upcoming rule change that will reduce the number of people subject to drug copays and the number of drugs subject to copays. This is not a COVID-19 change, it is phase 1 of a long-awaited change needed to comply with ACA income-based cost-sharing protections. In phase 2 expected in 2021 the copay cap will be adjusted from a fixed dollar amount ($250 per year) to a 2% percentage of income cap. 

What is not changing: drug copays are still no more than $3.65 and pharmacies still cannot refuse to fill a prescription if MassHealth members cannot afford copays. No new copays are being proposed. The $3 copay for an inpatient hospital stay was repealed in March 2020. 

However, starting July 1, individuals with income less than 50% of the poverty level will not be charged copays, and cash assistance recipients automatically eligible for Medicaid will also be exempt from copayments, also exempt will be more preventive drugs and drugs to treat substance use. 

MassHealth has already started mailing letters to members with information about the copay changes.  There is a powerpoint on the MassHealth Training Forum website with more information posted here.

4.      The end of Student Health Plan Premium Assistance:  Clarification that all students will be protected during COVID 19 from loss of MassHealth

When the 2019-20 academic year ends this summer, MassHealth will no longer purchase Student Health Plans for MassHealth members who are enrolling in college or university on a full time basis in 2020-21. This will affect about 30,000 students enrolled in 2019-20 who should all have received notices from the school, the school’s insurance broker and MassHealth by now.  More information is posted on the website of the broker here:

About 6000 of the 30,000 students got a letter that was slightly different than the others by including a bullet point advising the students to call Customer Service to check their eligibility for MassHealth. This is because MassHealth had information on file that these 6000 students would no longer be eligible for MassHealth at the end of the 2019-20 school year, and initially did not think they were protected by the COVID-19 termination moratorium. 

Last week, MassHealth clarified that all 30,000 students  enrolled in MassHealth on March 18 or later will be protected from losing coverage during the COVID 19 emergency including the 6000 who may now have income over MassHealth income limits. MassHealth will not be issuing new notices to these 6000 students, but they will all be getting information about selecting a managed care plan and if they call Customer Service, it will have updated information to explain that they remain eligible. 

5.      New fact sheet from National Consumer Law Center on the Stimulus Payment Prepaid Debit Cards not a scam & how to avoid fees


6.      MassHealth’s Summary of COVID 19 Eligibility Flexibilities

(June 2020)


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