MassHealth Advocacy Alert-Public Hearing Jan 30 Premium Assistance Overpayments
MassHealth Advocacy Alert
We need your help at an upcoming Jan 30, 2023 public hearing about MassHealth policies for collecting “overpayments” from MassHealth beneficiaries.
Currently, MassHealth collects Premium Assistance overpayments from beneficiaries in a way that is unlawful, unfair, and unforgiving.
· Any incorrectly paid benefit is subject to recovery even if the MassHealth member was not at fault in any way
· The notice of overpayment doesn’t adequately explain why benefits were not due, how the overpayment was calculated and is not in the primary language of the member
· If the overpayment is not paid, or a repayment plan made, MassHealth says it will intercept the individual’s state tax refund to repay it
· There are no provisions for waiver based on agency error, excusable member error or financial hardship
· Scroll down for two real life examples of the unfairness of the current Premium Assistance overpayment rules
MassHealth is proposing a temporary hardship waiver that doesn’t begin to address the problems with their current policies.
· The proposed rule provides for a temporary waiver or reduction of the monthly repayment amount in an approved repayment plan in the case of undue financial hardship.
o Only an individual who has first set up a repayment plan may apply for a hardship.
o The hardship waiver or reduction is only temporary & only for the amount of the monthly repayment amount
o The poorer someone is and the lower their monthly repayment, the less is the relief in the event of an undue hardship.
How should MassHealth amend its current Premium Assistance Overpayment policies
There should be no overpayment subject to recovery in at least the following situations –
· The beneficiary was initially required by MassHealth to enroll in employer-sponsored insurance and was enrolled at the time payments were made (See Anh’s story below)
· The overpayment was based on the employer’s change in health plan offerings
· The overpayment was based on an error by the agency
· The overpayment was based on an error in the information the employer supplied to the agency
· The agency failed to give an adequate notice explaining the reason for the overpayment and the right to appeal in the primary language of the member
· The payment was made in the same month in which the MassHealth beneficiary lost employment (See Jill’s story below)
· The overpayment was based on the beneficiary’s mistake, inadvertence or excusable oversight
· Repayment would create an undue financial hardship for the member or member’s family
How can you help?
Testify in person or submit written testimony opposing MassHealth’s draconian overpayment policy and recommending more meaningful relief for MassHealth beneficiaries. Tell MassHealth about --
· your experience with MassHealth premium assistance overpayments
· your knowledge of how other government programs waive or reduce overpayments
· your experience of the precarious financial situation of MassHealth beneficiaries
· the burden of medical debt and how it affects access to care
Public Hearing on Monday January 30, 2023 at 2 pm
130 CMR 506.000 Financial Requirements
130 CMR 506.012(F) (4)-(6) MassHealth Premium Assistance Overpayments
To Get instructions on how to join the hearing or register in advance, go to www.mass.gov/service-details/
To join the hearing by phone, call (646)(558-8656 and enter meeting ID 935 397 8200# when prompted
Written testimony may be submitted by email to masshealthpublicnotice@mass.
Please let us know if you are testifying or submitting written comments, need more information or have more information for us.
Here are two real life examples of MassHealth Premium Assistance Overpayment cases
Anh was a working parent whose family had MassHealth. Her primary language was Vietnamese. She was notified by MassHealth that she was required to enroll in her employer’s family coverage policy or MassHealth would end her coverage. It said MassHealth would reimburse her for her premium (Premium Assistance). She enrolled.
Her employer switched its coverage to a plan with a higher deductible; Anh continued paying her share of the premium and using her Premium Assistance reimbursement check to make up for the loss of income. Six months after Anh had been on the higher deductible plan, MassHealth notified Anh that it was ending her reimbursement and she owed the state $7000 for the past 6 months because the plan deductible didn’t meet its criteria any more. All the notices were in English.
Anh went to her appeal with a Vietnamese interpreter and a legal aid lawyer. Under the rules, if there was an overpayment, there is no exception for agency error, inadvertent beneficiary error or financial hardship. Anh won her appeal, but only because her lawyer proved that there was no overpayment because even with the higher deductible, the plan did in fact meet the criteria under the rules.
Jill was a single parent who worked nights so she could be home days to care for her daughter and her elderly mother. Her income varied but was generally 150-200% of the poverty level. She enrolled in her employer’s family coverage plan and, because her daughter had MassHealth, she also qualified for premium assistance. She had $400 per month in MassHealth premium assistance direct-deposited into her checking account to reimburse her for the monthly premium costs taken out of her pay. When she was laid off at the end of the month, her premium costs for that month’s coverage were still taken out of her pay. She used her premium assistance check that month as she had in past months to make up for the reduction in her take-home wages and pay her bills.
MassHealth notified Jill that she owed the state $400 because the Premium Assistance she received in the last month of employment was paid in advance for the next month’s coverage. A few months later, Jill got another job and signed up for her employer’s family coverage plan, her daughter still had MassHealth, but this time Jill didn’t apply for premium assistance, even though she was eligible for it and needed it, because she was afraid of falling into debt again.