Medicare Savings Program for CommonHealth members

April 2025 Update: In April 2025 MassHealth redetermined MSP eligibility for  14,000 CommonHealth members enrolled in Medicare. Approximately, 14,000 with income of 225% FPL or less were able to newly qualify for Medicare Savings Program (MSP) benefits or were upgraded from SLMB/QI to QMB. Attached is a redacted copy of an April 25 notice to one of these members. MassHealth also updated the FAQs on its MSP website to refer to MSP eligibility for people with income of 225% FPL or less as including those enrolled in MassHealth Standard "or CommonHealth." 

Background:

Attached are two letters from CMS to MassHealth that were instrumental in achieving the policy change planned for May 1, 2025 that will enable CommonHealth members with income of 225% FPL or less to qualify for Medicare Savings Programs (QMB to 190% FPL and SLMB/SI up to 225% FPL.  The first is a letter to the Medicaid Director dated Dec 31, 2024 that " summarizes recent activities and affirms our joint commitment to ensuring CommonHealth enrollees can access Medicare Savings Program premium assistance through the Medicaid state plan." The second is a CMS letter dated Jan 17, 2025 approving the state's request for a 1902(e)(14) waiver enabling it to temporarily based MSP eligibility for CommonHealth members on CommonHealth's MAGI income methodology in order to give the state time to make the system changes necessary to determine MSP for CommonHealth members using the MSP non-MAGI methodology.  

This policy change was precipitated by MassHealth plan to terminate MSP for certain CommonHealth members with income over 135% FPL  in the summer and fall of 2024 and the advocacy opposing those terminations described in an earlier post.