MassHealth Reinstated People Wrongly Terminated based on "Change in Household" Prior to March 31, 2023

MassHealth & MLRI

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 20,000 people who are entitled to have their benefits reinstated prior to April 1, 2023. One example of this is young adults terminated when their parents listed a new address for them --even though neither the parents or their adult children wanted to voluntarily withdraw. Attached is "Emma's" story -an account of one MassHealth member's experience trying to get her benefits restored in this situation..

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 has yet to be determined.

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 attached.

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.

Attached are copies of these two kinds of notices and a set of FAQs prepared by MassHealth for people receiving these notices. 

MassHealth has agreed to make changes to prevent these wrongful terminations after April 1, 2023. The agency's long term plan is to make system changes that will give the departing household member an opportunity to establish eligibility on another basis prior to termination. Until then it will have an interim plan. However, we do not have any more details at this time.

Please let us know if you have clients who were wrongly terminated based on household or address changes that were treated as voluntary withdrawals after April 1, 2023A redacted copy of one of these "not in household" termination notices is attached. and