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Miscellaneous Health Updates

Listed below are 4 updates on national health reform litigation & small employer tax credits; a fair hearing decision regarding newish MassHealth "program integrity" policies to identify non-residents, and the change in state law limiting the dates when certain individuals can buy individual insurance on their own.

1. The National Health Law program is keeping track of the litigation challenging national health reform. It reports that a federal court in New Jersey recently dismissed one such challenge. This is the fifth reform challenge to be dismissed (joining dismissals occurring in the E.D. Mich.; E.D. Tenn.; W.D. Va.; and S.D. Cal.). The Michigan (Thomas More Law Center v. Obama), Virginia (Liberty Univ. v. Geithner) and California (Baldwin v. Sebelius) cases have been appealed to the 6th, 4th, and 9th circuit courts of appeals, respectively.

For more info, see the NHelp webpage on health reform litigation 

2.  Here is a link to a 3-page flyer prepared by MLRI with information about the small employer tax credit for 2010 --this credit is also available to small (& low paying) tax exempt organizations & may be available to benefit your employer, organizations with which you work or volunteer, or client groups who have at least one employee for whom they provide insurance.

3. A LACCM advcocate won a recent fair hearing decision (posted on the masslegalservices.org site for legal services advocates) in a case involving a PARIS match --this is a data match of individuals receiving Medicaid in another state. The Office of Medicaid starting using this system about a year ago. We will likely be seeing more clients who have benefits wrongly terminated due to "program integrity" procedures. In this case, a Spanish-speaking client got an English language notice with a deadline for proving residence in Mass. based on a computer match showing he was getting Medicaid in another state, he missed the deadline & benefits were terminated in a Spanish notice that he appealed. He supplied proof of Mass. residence but benefits were reinstated only after a gap in coverage during which he'd incurred substantial medical expenses. At the hearing, his representative showed he had been a Mass. resident for years & his Medicaid in another state had also ended years ago & retro benefits were awarded. Thanks to this case, MassHealth has also agreed to translate PARIS match notices into Spanish in future. It also highlights problems with bad matches continuing after a MH member proves MA residence--more work is needed to solve that problem.

Remember to keep sending us hearing decisions that raise new issues or may be helpful to your colleagues!

4. Here is a link to a Dec. 1 Bulletin from the state Dept. of Insurance with more information on the new open enrollment limitations for people buying insurance on their own. MLRI is interested to hear if any lower income people have been affected by this change in the law. It's designed to discourage people from buying insurance when they get sick & dropping it when they get better but may be having some other unintended consequences. 

Vicky & Neil