May 31, 2022 Health Update

Senate wraps up FY 23 budget, next stop conference committee

Medicare Saving Program expansion proposed for Jan 2023. Both chambers provided for a further expansion of the upper income limits for the Medicare Savings Programs (Senior Buy In and Buy In) effective Jan. 1, 2023 with the only question being how much higher than the current 165% FPL upper limit, the final bill will go. The Senate goes up to 225% FPL (Senate Section 31), the House to 250% FPL (House Section 28).

Reimposing an asset test proposed for EAEDC eligibility for rest home residents.  Last year the legislature repealed the asset test for TAFDC and EAEDC. This session both chambers have enacted provisions imposing a $2000 EAEDC asset test for rest home residents. (House Section 27A; Senate Section 29). This implicates MassHealth because EAEDC beneficiaries are automatically eligible for MassHealth. 

IRS proposes end to “family glitch” which now stands in the way of affordable coverage for certain employees’ dependents  –comments due June 6

The following information and the short template comments attached are from Hannah Frigand at Health Care for All. hfrigand@hcfama.org

Last month the Biden administration announced a proposed rule fixing the “family glitch” that has blocked some families from receiving premium tax credits under the Affordable Care Act, including approximately 44,000 individuals in Massachusetts (according to the Urban Institute). The family glitch refers to the current affordability test used to determine eligibility for premium tax credits, which only considers the cost of the employee-only plan, not the cost of a family plan. As a result, many workers and their family members cannot receive premium tax credits. Removing the family glitch will allow thousands of Massachusetts residents to enroll into ConnectorCare or get lower cost coverage with premium tax credits. Here is some background information on this issue. 

We hope you will join us in submitting supportive comments on the proposed rule. The deadline to submit comments is June 6th. Your comments can be submitted here.

Ukrainian Emergency Appropriations Act extends refugee benefits to Humanitarian Parolees

May 21 2022 Update: The President signed an emergency appropriation bill for the situation in the Ukraine. It  provides that Ukrainians granted humanitarian parole  between February 24, 2022 and September 30, 2023; and certain of their family members paroled after Sept 30, 2023 will be eligible for the same public  benefits as refugees until their parole ends. 

A similar provision with different dates was enacted for Afghan evacuees. All people with humanitarian parole already had access to comprehensive coverage from either MassHealth or the Health Connector but the refugee treatment opens the door to full Medicaid (MassHealth Standard) benefits as well as benefits from SNAP and other programs including refugee-specific assistance.

The federal public health emergency will extend beyond mid-July as MassHealth continues planning for the unwinding now expected in the fall

The US Secretary of HHS has extended the COVID-19 public health emergency (PHE) for 90 days at a time since January 2020, most recently to mid-July 2022. The current Secretary has consistently promised the states 60 days advance notice of the end of the PHE, and by giving no such notice in mid-May, signaled that another extension can be expected. For Medicaid programs, extending the PHE means the continuous coverage protection and enhanced federal matching funds will also be extended. CMS, state Medicaid agencies, and advocacy groups are all working on policies for the “unwinding” that will avoid eligible beneficiaries losing coverage in the transition to normal operations. See CMS materials here.

The best information we have so far from MassHealth is that total current enrollment is 2.2 million, over 450,000 (25%) higher than enrollment before the PHE. MassHealth resumed sending out renewal forms in May 2021 –since then the return rate is only 27% for those in HIX, and 10% for those in MA-21.  Over 700,000 people are now “protected” in MassHealth coverage most because they did not return renewal forms or respond to requests for information (MassHealth doesn’t track how many non-responses are due to bad addresses). Of the people “protected” in coverage,  630,000 are primarily people under age 65 subject to the MAGI income rules and determined eligible in the HIX computer system; 70,000 are people subject to an asset test including seniors and nursing home residents in the MA-21 computer system. Please let us know if you are currently working on unwinding issues or would like to be. vpulos@mlri.org and ksymmonds@mlri.org

Medicare proposes beneficiary enrollment simplification rules including new special enrollment periods --–comments due June  27

Included in this proposed rule are several new Medicare Special Enrollment Periods that will make it easier for people who miss their initial enrollment period and don’t qualify for Medicaid or MSP to still avoid enrollment delays and financial penalties. The proposed new SEPs are: 

• An SEP for Individuals Impacted by an Emergency or Disaster that would allow CMS to provide relief to those beneficiaries who missed an enrollment opportunity because they were impacted by a disaster or other emergency as declared by a Federal, state, or local government entity.
• An SEP for Health Plan or Employer Error that would provide relief in instances where an individual can demonstrate that their employer or health plan materially misrepresented information related to enrolling in Medicare timely.
• An SEP for Formerly Incarcerated Individuals that would allow individuals to enroll following their release from correctional facilities. (Read more about the barriers Medicare now erects at reentry and further reforms needed in this issue brief from Justice in Aging  here).
•  An SEP to Coordinate with Termination of Medicaid Coverage that would allow individuals to enroll after termination of Medicaid eligibility.
• An SEP for Other Exceptional Conditions that would, on a case-by-case basis, grant an enrollment period to an individual when circumstances beyond the individual’s control prevented them from enrolling during the IEP, GEP or other SEPs.

Learn more about the proposed rule in this CMS fact sheet. The public comment period on the rule is open through June 27

More free COVID test kits per household

On  May 17, 2022, HHS announced a third round of free at-home COVID antigen test kits per household –there are 8 tests in this round. https://www.covid.gov/tests (also links to free PCR test sites in each state).  People with MassHealth or Health Safety Net can get 8 test kits per month without a prescription as part of their covered pharmacy benefit.