March 31, 2023 Health Update

Health-Law-Announcements

2023 Plan Assignments Take Effect on April 1, 2023 –MassHealth extends Customer Service hours this weekend

An estimated 40% of 1.2 million MassHealth members in mandatory managed care may have new plans on April 1. MassHealth has extended its hours of operation to handle any problems filling prescriptions over the weekend related to plan changes. The Customer Service Center (800-841-2900)  will be open Sat April 1 from 8 am to 4 pm and Sunday April 2 from 8 am to 1 pm.

There is more information posted on MLS about the April 1, 2023 plan changes here

 

MassHealth mails thousands of retroactive reinstatement notices  prior to April 1, 2023

MassHealth has sent out notices this month to a large group of people to retroactively reinstate their MassHealth benefits.  There are two different reasons for these reinstatements.

1.      CMS directed Medicaid agencies to reinstate duals who were downgraded to only a Medicare Savings Program (MSP) prior to March 31, 2023

MassHealth is reinstating about 2500 duals who were downgraded between July 1, 2021 -July 31, 2022 

These Medicare beneficiaries had their MassHealth benefits reduced to MSP benefits that pay for a Medicare Part B premium and sometimes other Medicare cost-sharing, despite the federal continuous coverage protection, based on a change in policy by CMS. They are now entitled to  have their MassHealth benefits restored because a court has ordered CMS to go back to its old policy and notify states to reinstate benefits wrongly reduced. The lawsuit was called Carr v Becerra. 

 MassHealth is reinstating benefits retroactively to everyone they identified as affected during the 13 months they implemented the CMS rule. These 2500 people will remain eligible until they get a renewal notice dated  April 1, 2023 or later and receive a new determination based on that renewal. The March 2023 notice supplies a telephone number to the MassHealth unit designated to  field questions (not the general Customer Service Center 800 #). People may have questions about how to be reimbursed for services they paid for or how to have unpaid bills incurred during the retro period covered. People who do not want to be reinstated can also call to opt out. 

The Court Orders, an Example of the Letters CMS sent to states, a letter from advocates to MassHealth, and a template of the MassHealth Carr v Becerra notices mailed out in March 2023 are all posted here.

 

2.      MassHealth is also reinstating a larger group of beneficiaries who its computer system had incorrectly treated as voluntarily withdrawing from services.

Over the last six months, advocates have brought cases to light of people losing MassHealth despite the continuous coverage protection  based on reported changes that were treated by the computer system as voluntary withdrawals when that was not what the member intended. A voluntary withdrawal was one of the few exceptions to the Medicaid continuous coverage protection. After investigating these and other cases, MassHealth has identified thousands of people who are entitled to have their benefits reinstated. 

In late March MassHealth sent out two different reinstatement letters. One went to people who had been terminated and had not yet reestablished eligibility for MassHealth benefits, the other went to people who had reestablished eligibility,  but only after a gap period in which they had no coverage. A remedy for a third group of people who had been terminated and were now enrolled in ConnectorCare is still under review. 

The notice supplies a telephone number to the MassHealth unit designated to field questions (not the general Customer Service Center 800 #) such as how to be reimbursed for covered services paid or how to have unpaid bills incurred for covered services during the retro period paid. People who do not want to be reinstated can also call to opt out. Template notices are posted here.

Like all MassHealth members enrolled after March 18, 2020 through March 31, 2023 these individuals will remain eligible until they are selected for renewal at some point after April 1, 2023 and receive a new determination based on that renewal. 

How these system issues will be addressed after April 1, 2023 remains to be determined.

 

If you have clients who received any of these reinstatement letters, please let us know how the process is working out for them. We’re interested in hearing both about any problems or confusion as well as the value to your clients of regaining coverage or clearing up medical debt. vpulos@mlri.org and ksymmonds@mlri.org