Health Update & Next Health Care Working Group Sept 27


The zoom link should be in your calendar. We’ll resend the link early next week.


Health Updates for Sept. 22, 2023

MassHealth Redeterminations

CMS Letter to States on “Ex Parte” Renewals and Mitigation Plans: Up to 10,000 MassHealth members may be affected

On August 30, 2023, CMS sent a letter to all the States about a mistake that some states were making in the way they renewed people in multi-person households that resulted in eligible individuals in the household being improperly disenrolled. It required all states to test their systems for compliance with requirements, and if non-compliant to immediately pause redetermination for affected individuals, reinstate coverage for those improperly disenrolled, fix the systems, and in the meantime implement mitigation strategies.

Under federal rules, states try to renew eligibility based on information they already have in the file or can update with data matching, this is an “ex parte” renewal. Only if there isn’t enough information to do that, may the state send out a renewal form putting people at risk of losing coverage for failure to return the form and other proofs. In the August letter, CMS makes clear these “ex parte” renewals should be happening at the individual level not at the household level in order to take account of differing eligibility rules for individuals in the same household. All states were required to report back to CMS on September 13, 2023 about whether or not their systems were in compliance with individual ex parte renewals, and, if not, with additional information on the population of individuals affected and the state’s plan and timeline for reinstatement and implementation of mitigation strategies.

CMS August 23 letter to states

Mitigation Plan Template (for the states to report back to CMS by 9.13.23)

CMS Preliminary Overview of State Assessments 9.21.23

What does this mean for Massachusetts?

According to the CMS Preliminary Overview, Massachusetts is one of 30 states not in compliance with ex parte renewals at the individual level; the non-compliance affects household members with different eligibility statuses, and  the number of people who may have been improperly disenrolled is 10,000 or fewer. We don’t have a copy of the Sept 13, 2023 Massachusetts assessment, and don’t yet have further details.

Who may have been improperly disenrolled?

In Massachusetts, if everyone in the household can’t be renewed ex parte, MassHealth sends out a renewal form to the head of household. However, the consequences for not returning the form (or other proofs) differ between the (mostly) under 65 and (mostly) 65 or over.

Under 65 MAGI

For people under 65 subject to the MAGI income rules, no asset test and in the HIX eligibility system, if the renewal form or a request for additional information related to the renewal is not returned by the deadline, but data is available, the state makes an individualized determination based on the data. 130 CMR § 502.007(C) (2)(b) 2. It does not terminate everyone in the household because the form was not returned. Instead, in this situation, individuals who could have been renewed ex parte should still be renewed based on the data.

65 and older non-MAGI

However, for people 65 and older subject to non-MAGI income rules and an asset test and in the MA-21 eligibility system, failure to return a renewal form or request for information will result in termination of all benefits for all household members including those who could have been renewed ex parte without any additional information. 130 CMR § 516.007(C)(2)(b) 2. 

When we met with MassHealth about this early in September the agency was still assessing the situations where wrongful terminations may have occurred. However, it appeared most were going to affect older couples on MassHealth who were subject to different eligibility rules, such as couples in which one spouse qualified under the poverty level income standard and the other spouse for a program with higher income limits like HCBS, PACE or the PCA deduction. More to come on this as we learn more.


Summary of MassHealth’s Temporary Authority To Streamline Redeterminations During the Post-COVID “Unwinding” Period

The federal Medicaid agency has encouraged states to obtain temporary waivers under Section 1902(e)(14) of the Social Security Act to enable more eligible beneficiaries to successfully renew their coverage during the post-COVID 19 “unwinding period.”  Massachusetts has recently gotten approval for several of these waivers which should significantly ease the burden of renewal and minimize gaps in coverage for the elderly and people who are initially terminated for procedural reasons.

MassHealth has posted the CMS letters approving its temporary waivers here.

1.      Waiver of Asset Test (Approved by CMS 9.5.23)

2.      90 Day Retroactive Reinstatement (Approved by CMS 9.5.23)

3.      Waiver of verification of 0-income (Approved by CMS 7.24.23)

4.      Member Designation of Certified Application Counselors via telephone (Approved by CMS 8.2.23) (effective May 12, 2023 to May 31, 2024)


1.                Waiver of Asset Test (Approved by CMS 9.5.23).

What it does?

CMS authorizes MassHealth to temporarily waive the beneficiary asset test for renewals for non-MAGI eligibility groups subject to an asset test. There is no change in the rules to review income and eligibility factors other than assets.

When it applies?

Effective Sept 1, 2023 and remains effective for renewals begun through the end of the 12-month unwinding period. (April 1, 2023 to March 31, 2024)

How is MassHealth implementing it? Nothing has yet been released. However, EOM 23-23 and EOM 23-18 did describe an earlier  more limited asset disregard as follows:

Disregard of resources for residents of a skilled nursing facility or participants in home and-community-based services waiver programs

• Applies to income that would otherwise have been included in their PPA or member contribution and became a countable resource.



When will MassHealth release guidance on this?


How will people selected for renewal know that there is no need to supply asset information?


How will this apply to people who were selected for renewal prior to September 1, 2023 who have not yet verified assets or were terminated for not verifying assets?


How will this apply to MAGI beneficiaries now renewing as non-MAGI with the SACA-2 e.g. people turning 65 or older parent/caretakers of dependent children who turned 19, or people under 65 seeking HCBS or PACE on renewal?


2.      90 Day Retroactive Reinstatement (Approved by CMS 9.5.23)

What it does?

CMS authorizes MassHealth to temporarily reinstate eligibility effective on the individual’s prior termination date for individuals who were disenrolled based on a procedural reason and are subsequently redetermined eligible for Medicaid during the state’s reconsideration period (for a period of up to 90 days) This authority applies to both Medicaid (MAGI and non-MAGI eligibility groups) and CHIP populations.

When it applies? The authority is effective April 1, 2023, and will remain effective until 17 months after the end of the continuous enrollment condition (i.e., August 31, 2024)

How is MassHealth implementing it?  MassHealth Eligibility Operations Memos on Policy Updates to Support Return to Normal Business Operations (April 1, 2023 – March 31, 2024) in March 2023 and in July 2023 (EOM 23-18) described this policy as follows:

Renewal applications may be reconsidered up to 90 days if benefits were terminated because the renewal application was not received by the due date, the renewal will be reconsidered if it is received within 90 days of the termination. There will be no gap in coverage if the member is still eligible.


Reconsideration Period

• If a member submits their renewal application within 90 days of the termination date, and is determined eligible for a MassHealth benefit, the start date will be retroactive to the date of the termination.

• MassHealth will automatically provide this start date to all eligible members that complete their renewal application within 90 days of their benefit termination.



CMS has authorized 90-day retroactive reinstatement for terminations for any procedural reason that would include failure to reply to verifications , why does the EOM say it is only for failure to return the renewal application?


The EOM says that MassHealth will automatically provide the retroactive start date when it applies. However, MassHealth has told us this process is not automatic. Members must know about this retroactive coverage and call to request it. Currently, neither the notice of termination nor the notice of reinstatement include any notice about the right to retroactive reinstatement or how to obtain it. How will MassHealth address this problem?


3.      Waiver of verification of 0-income (Approved by CMS 7.24.23)

What it does?

CMS authorizes MassHealth to complete ex parte renewals when no income data is returned from data sources for individuals who were previously enrolled or whose coverage was renewed based on a verified attestation of zero-dollar income. The previous verification of no income must have been March 2019 or later. (MassHealth has an attestation to verify zero income  that people previously had to sign and return to verify no income).

When it applies? Effective June 18, 2023, and remains effective for renewals initiated through the end of the state’s 12-month unwinding period, (April 1, 2023 to March 31, 2024)

How is MassHealth implementing it? We aren’t aware of any written description, but ex parte renewals can be implemented without requiring members to take any action.


Check out MLRI’s MassHealth Redetermination Monitoring webpage here.


Comments on Proposed Amendments to 1115 Demonstration Filed by Sept. 9, 2023

September 9, 2023 was the close of the comment period on eight proposed amendments to the 1115 demonstration including proposals to: 

o   Provide 12-months continuous eligibility for all adults (continuous eligibility for children is already required as of Jan 1, 2024),

o   provide certain MassHealth services for 90 days prior to release from incarceration,

o   reinstate 3-months retroactive coverage for the remaining adults not eligible for it under the current waiver,

o   create a medical respite benefit for people who are homeless, and

o   improve implementation of state statutory expansions of the Medicare Savings Program

We posted comments that MLRI wrote, co-wrote with CHLPI on pre-release services,  or endorsed here.  The comments support all the amendments but make recommendations to clarify or strengthen several of the proposal including 

  • involving more stakeholder from the community and with experience of the carceral system in planning pre-release services, 
  • expanding medical respite for the homeless to more than just ACO members, 
  • implementing 3-months retroactive coverage without waiting for the waiver authority to be removed, 
  • and addressing the scheduled sunset of Medicare Savings Program benefits for CommonHealth members in 2026 unless the agency submits an amendment that satisfies federal requirements.


 If any other list members submitted comments, we'd love to see them.