Health Update October 13, 2023
1. MassHealth Health Connector: Open Enrollment 2024
2. New Escalation Protocol for MassHealth Problem Cases
3. Reminder about MyServices.gov
Massachusetts Health Connector: Open Enrollment 2024
Open Enrollment for the Health Connector is just around the corner, Nov 1, 2023 –Jan 23, 2024 for coverage starting in 2024. The Health Connector sent out preliminary redetermination notices to its current members and an opportunity to update their information and in October is sending out “final” notices. But Health Connector members still have time to update their information or change health plans for 2024. And for the many individuals who have been eligible for ConnectorCare but unenrolled in 2023, they can still enroll for 2023 coverage if they act by Oct 23 for Nov 1 2023 or Nov 23 for Dec 1, 2023.
Major changes for ConnectorCare in 2024
In 2024, ConnectorCare’s upper income limit will go from 300% FPL ($43,740 per year) to 500% FPL ($72,900 per year) under a 2-year pilot program approved as part of the FY 24 state budget. In addition, several of the major commercial carriers that have never before participated in either ConnectorCare or MassHealth will be participating in ConnectorCare --albeit at a hefty premium compared to other plans. The new plans are Blue Cross Blue Shield, United and Harvard Pilgrim Health Care. and MGB is now offering two different products MGB Complete and MGB Select. All ConnectorCare plans offer the same covered benefits with the same schedule of copays. They differ in their provider networks with the lower cost plans having narrower networks and the higher cost plans having broader networks. ConnectorCare will also be eliminating copayments for certain drugs that treat chronic conditions like hypertension, diabetes and asthma in 2024.
The 300.1% -500% FPL income range will join the 200.1%-300% FPL in Plan Type 3 with the same schedule of copayments for people with income from $29, 161 to $72,900 for 1 person in 2024. Plan Type three which is now divided into PT 3A for those from 200.1% to 250% FPL and PT 3B for those from 250.1% to 300% FPL will have a new PT 3C for those from 300.1% to 400% FPL and PT 3D for those from 400.1% to 500% FPL. The “lowest cost premium” for purposes of calculating any added state subsidy will be $96 per person for PT 3A and $142 for PT 3B ($3 more than in 2023) and $219 for the new PT3C and $255 for the new PT 3D. However, available premiums may be lower based on the more generous federal tax credit in recent years. The Health Connector’s Get an Estimate Tool is still the best way to assess likely plan costs before actually applying for a plan. It has not yet been updated for 2024 but should be by Nov. 1, 2023. We will be updating MLRI’s FPL Table for OE 2024 to include PT3C and 3D.
New Escalation Protocol for Problem MassHealth Cases: The Service Solution Unit (SSU)
MassHealth is standing up a new process to “escalate” problem MassHealth cases after initial attempts to resolve an issue with MassHealth Customer Service or the MassHealth Enrollment Center or other units within MassHealth have not been successful. Attached is a PowerPoint explaining how to send a secure email with client identifying information to the SSU. They ask that requests for assistance be sent using a standardized template also attached as a Word document. Requests for assistance can be categorized as Level 1 urgent, Level 2 risk of loss of coverage or Level 3 general information. The range of issues that they can address is very broad. The reference in the slides to “triage to SME as necessary” means that the SSU will refer cases to other Subject Matter Experts (SME) within MassHealth when needed. The subject line should indicate the “Group.” There are three Groups: Eligibility, Program, and Long Term Cases that are explained further on slide 5. The usual confidentiality rules apply so advocates will need to have release forms or authorizations on file in order to receive a reply. If your query goes through, you should initially receive an acknowledgment with a ticket number.
See attached Powerpoint and Template
MassHealth is also continuing to enhance the content on the Myservices portal that it rolled out in June 2023