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Urgent Coverage Alert for Dually Eligible MassHealth Members

Urgent Coverage Alert for Dually Eligible MassHealth Members –July 19, 2021


Over the fourth of July weekend, MassHealth ended COVID continuous coverage protections for elderly & disabled individuals who are dually eligible for MassHealth and Medicare and who --

1. are no longer eligible for their current MassHealth coverage, 

2. are eligible for Medicare Savings Programs also known as the Senior Buy-In and Buy-in or as the QMB, SLMB and QI programs, and 

3. are subject to a redetermination on or after July 6, 2021 because they reported a change or responded to a request for information or renewal form including situations where changes were reported and forms returned earlier than July 6, 2021 but not acted upon until July 6, 2021 or later.

MassHealth will be terminating MassHealth Standard and downgrading benefits to only the Senior Buy In or Buy In for the elderly & people with disabilities despite the continuation of the federal public health emergency!


Who will remain protected in current coverage?

·         Dually eligible individuals who fail to report a change or fail to return forms will not lose their current coverage for that reason during the federal public health emergency.

·         Dually eligible individuals who are redetermined on or after July 6 and are no longer eligible for either their current coverage or a Medicare Savings program will also remain protected in their current coverage.


How will this downgrade affect the elderly & people with disabilities? 

The Senior Buy In or Buy In programs only pay for Medicare cost-sharing. Affected elderly & disabled individuals downgraded from Standard will lose enrollment in One Care or SCO or any of the HCBS waiver programs, and will lose all MassHealth-covered LTSS such as long term nursing home care, PCAs, adult day health, adult foster care, as well as MassHealth covered dental and non-emergency transportation. People only eligible for the Buy In (SLMB and QI) will also lose MassHealth coverage for their Medicare Part A and B deductibles, coinsurance and copayments.


How has MassHealth communicated this policy to its members, the public and the certified enrollment counselors, and Navigators?

It hasn't. Affected members will receive only the usual 10 day advance notice of termination of MassHealth Standard and notice of eligibility for the Senior Buy In or Buy In. There has been no alert or training for assisters and navigators. The public documents explaining the continuous coverage protection and even the May 2021 update to the continuous coverage protection still say this kind of downgrade is not allowed during the public health emergency. We don't know if there has been any communication to nursing homes, PACE and HCBS programs, One Care, SCO or any other providers serving dually eligible people


What can you do?

Advise clients about appealing in time to continue benefits pending appeal. If you have a patient/client who has received a downgrade notice, make sure they know they have a right to appeal and maintain their current coverage IF the Board of Hearings receives their appeal within 10 days of the mailing date or before the date of the change in coverage whichever is later.

Email us. Please let us know if you have a client or patient who has gotten one of these downgrade notices. MLRI does not have an intake system, so please do not send clients to us directly yet. &

Advise patients and clients about their options to remain eligible for Standard or qualify for CommonHealth

Many of the individuals who will be affected are those who turned 65 and now have an asset test for the first time and a lower income ceiling to remain eligible for Standard. Make sure patients and clients. You can help:

1. Make sure exempt Economic Incentive payments (& other tax credits) are not counted as assets.  When reporting assets,  Economic Incentive Payments (EIP) do not count as assets for 12 months from receipt.  As far as we know, MassHealth only exempts these assets if the individual knows to supply verification via bank statement or self-attestation to show how much of their current bank balance represents an Economic Incentive Payment received less than 12 months ago. Remember these payments were generally $1200 per adult with payment starting in April 2020, $600 per adult with payments starting in Jan 2021 and $1400 per adult with payments starting April 2021. But people may have received payments at different times, and some payments were in the form of debit cards & may have been deposited as cash in lower amounts, and there were added allowances for qualified children. Dually eligible adults with dependent children may also be receiving advance child tax credits starting July 15, 2021. These child tax credits, like the EIP, do not count as income in the month of receipt or as an asset for 12 months after receipt. Assets can be verified by self-attestation until Sept. 15, 2021.

MassHealth has not communicated with members, the public or CACs or navigators about the need to verify what amount of a bank balance represents EIP payments to assure that exempt assets are not counted. 


2. Inform members of their options for spending down assets. Individuals whose assets exceed the $2000/$3000 countable asset allowance for MassHealth should be informed that they may spend down their assets before returning the renewal form or responding to information. Remember those who do not return a form will remain protected. 


Members can spend down their assets by paying bills, or buying anything they need or want.  They can also invest in a non-countable asset like  a burial account. A spouse in a nursing home or HCBS waiver program can transfer money to their spouse without a penalty. However, transferring money to someone else may disqualify the member from future eligibility for nursing home care or a home and community based waiver.


3. Refer potentially eligible members for HCBS waivers or PACE. Individuals who are now over-income for MassHealth Standard may still be able to qualify for MassHealth Standard under the Frail Elder Waiver (60 or older) or one of the other HCBS waivers for people with developmental disabilities or brain injuries or nursing home stays or for the PACE program (55 or older). This requires a referral to an ASAP (frail elder waiver)  or DDS (developmental disability) or  MRC (brain injury) or U Mass (nursing home residents) for a determination that someone is medically eligible. For PACE, contact the PACE organization. HCBS waivers and PACE treat the individual as a household of one with an countable income of $ $2382 per month or less, and countable assets of $2000 or less. In HCBS, spousal assets are not counted unless they exceed $130,380 and there is no penalty to the member for transferring assets from the member to a spouse. In PACE spousal assets are not counted at all.

We don't know if MassHealth has communicated this policy change to the Dept of Elder Affairs or DDS.


4. Refer potentially eligible members to CommonHealth for working disabled. Individuals who are now over-income or over-assets for MassHealth Standard may be eligible for CommonHealth for the working disabled which has no asset test and no upper income limit but a sliding scale premium charge for people with income over 150% FPL. To qualify, an individual must be working disabled and working at least 40 hours per month or 240 hours in the past 6 months. If an individual has not yet been determined disabled, they can still self-attest to disability by calling the Disability Evaluation Service until Sept. 15, 2021 


5. Inform eligible members about the PCA deduction. Individuals age 65 or older who have a PCA or need a PCA and will apply for one within 90 days can qualify for a special income deduction that effectively raises the 100% FPL income standard to 133% FPL, and even if their income exceeds 133% FPL, they will be able to apply the PCA deduction to reduce the amount of their 6-month spenddown. To qualify for  PCA deduction someone must need hands-on help with activities of daily living like getting in and out of bed, using the toilet, bathing, dressing, and eating. 


6. Check for Deemed SSI status. Individuals who are now over-income for MassHealth Standard but had SSI at some time in the past and lost it based on the higher amount of their Social Security Insurance Based benefits may still be eligible under special rules that still treat them as if they were eligible for SSI. These are known as "deemed SSI" statuses. These special rules apply If the individual would be eligible for SSI but for cost of living adjustments to their Social Security since their SSI ended or if they lost SSI based on the receipt of a higher amount of Social Security benefits as the disabled adult child  of a parent who is retired, disabled or deceased. 


7. Look out for erroneous Medicare Savings Program determinations  

So far we have only seen one of these downgrade notices. In that case a senior renewal was returned in mid-April but not redetermined until July 6, 2021. The redetermination counted exempt Economic Incentive Payments received in prior months as current assets, failed to apply the Frail Elder Waiver criteria to someone enrolled in a FEW since 2018, and even based on its incorrect income and asset calculations, incorrectly found this couple eligible for the Buy In but not the Senior Buy In. 


Is this legal?  We'll get back to you on that. Please email us if you have an affected patient or client. and