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2023 Upper Income Limits in MassHealth and Health Connector

MLRI & MassHealth
MassHealth updates its income standards with the current year's poverty level on March 1. Attached is MLRI's table showing the upper income levels for MassHealth and Health Connector programs, updated to show the cost of living adjustments for 2023 that take effect in MassHealth…

Comments on Proposed MassHealth 1115 Amendments

MLRI, CHLPI, HCFA
In August 2023 MassHealth proposed 8 amendments to the current 1115 demonstration, with an opportunity to comment by Sept 9, 2023 including proposals to:  Provide 12-months continuous eligibility for all adults (continuous eligibility for children is already required as of Jan 1,…

What's in the Blue Envelope for People Turning 65

MassHealth
MassHealth is in the process of renewing eligibility for all its 2.4 million members during the one year period from April 1, 2023 to March 31, 2024. If eligibility can't be renewed through data matching, beneficiaries will be sent a blue envelope with a notice dated April 1, 2023 or later to be…

MassHealth Renewal: What's in the blue envelope for people under 65?

MasHealth
MassHealth is in the process of renewing eligibility for all its 2.4 million members during the one year period from April 1, 2023 to March 31, 2024. If eligibility can't be renewed through data matching, beneficiaries will be sent a blue envelope with a notice dated April 1, 2023 or later to be…

Elder Benefits Programs -- BBT Training

CLA, DLC, GBLS, MLRI, GSSSI
Materials from the May 2, 2023 Elder Benefits training, presented as part of the MLRI/MCLE Basic Benefits Training Series: Agenda Faculty Bios Presentations MassHealth for Community Residents (pdf of slides) SSA Benefits for Elders (pdf of slides) MassHealth Long Term…

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…

MassHealth Managed Care Options in 2023

Various
On April 1, 2023 MassHealth members subject to mandatory managed care will have a new set of managed care options. These changes do not apply to people 65 or over or Medicare beneficiaries with voluntary managed options in SCO or One Care, or to other MassHealth members with MassHealth secondary to…

Understanding immigrants' eligibility for MassHealth & other subsidized coverage, March 2023

Vicky Pulos, MLRI
This  updated March 2023 memo summarizes the current immigrant eligibility rules that MassHealth and the Health Connector use in making decisions about what kinds of coverage non-citizens with different kinds of status can receive. The update reflects federal law changes in 2021…

CMS directs Medicaid agencies to reinstate duals who were downgraded to Medicare Savings Programs only

CMS
On Mar 7, 2023 CMS issued a notice to all state Medicaid agencies pursuant to an injunction entered against CMS in a nationwide class action called Carr v Becerra filed in federal district court in Connecticut. The class consisted of people who had been determined eligible for Medicaid after…

Health Care Access Programs -- BBT Training

MLRI, GBLS, HCFA,
Materials from the February 27, 2023 Health Care Access Programs training, presented as part of the MLRI/MCLE Basic Benefits Training Series: Handout Materials Agenda (pdf) Faculty Bios How to Apply for Public Health Insurance Benefits in Massachusetts (pdf of…

Health Benefits for All Massachusetts Residents Regardless of Citizenship

MLRI
A list of health programs available to all Massachusetts residents regardless of US citizenship or immigration status with a short description of each program and information on how to apply; in English, Spanish & Portuguese. Updated in February 2023 with information on COVID-19.

A bill to reinstate 3 months retroactive MassHalth Coverage in 2023

MHA & MLRI
Attached is a fact sheet on a bill filed in the 2023 session to restore retroactive MassHealth coverage; MassHealth plans to end this coverage for new applicants 19-64 who are not pregnant when the COVID-19 Public Health Emergency ends expected to be this spring.

Federal Poverty Guidelines - 2023

MLRI
The charts below set forth the annual, monthly and weekly 2023 Federal Poverty Guidelines (based on HHS thresholds).  In addition, the annual, monthly and weekly 115% of poverty, 125% of poverty,  187.5%, 200% of poverty and 300% of poverty amounts are listed. Finally, you…

COVID-19 Related Changes Affecting MassHealth, Health Connecter, and Health Safety Net

MLRI
UPDATE MAY 11, 2023 END OF FEDERAL COVID-19 PUBLIC HEALTH EMERGENCY On May 11, 2023 the Secretary of HHS ended the federal COVID-19 Public Health Emergency. See related materials here The COVID-19 Health Changes Table was last updated in March 2023 and should only be used as a reference for…

Student Health Insurance Flyer

Massachusetts Law Reform Institute
In Massachusetts, college students must have health insurance. Students will be enrolled in their school-based insurance, unless they have other coverage and waive the school-based insurance by their school's deadline.    MLRI made the attached flyer (see English and Spanish…

Record Requests

MLRI & others
Attached are sample documents making a public record request to the MassHealth agency, and appealing from the agency's failure to supply the requested records.  The Secretary of State oversees compliance with the state public record law & puts out a guide to the law. This…

MassHealth Behavioral Health for Criminal Justice Involved People

MassHealth
This MassHealth website describes a program to connect "justice-involved" people with  behavioral health services & social supports in the community. "Justice-involved" includes:  • people leaving jail or prison within six months, • people who…

Tips for Communicating with Optum

MLRI
This May 2022 updated memo by MLRI provides contact information for MassHealth's Third Party Administrator for certain Long Term Services and Supports (LTSS), Optum. Optum began making prior authorization decisions for PCA and certain other LTSS services in the summer of 2017. The updated…

MassHealth Managed Care Contracts

MassHealth
At this website MassHealth has posted its contracts with its managed care plans including the MCOs, the ACOs, the Behavioral Health Partnership, and the One Care and SCO plans. When researching the scope of covered services for a beneficiary enrolled in a managed care plan, the contract may have…

CCA One Care Coverage Exceptions for non-covered benefits

Various
In Feb 2022 CCA updated and published its Medical Necessity Guidelines for otherwise NonCovered Services (PDF is attached) & posted it here: https://www.commonwealthcarealliance.org/ma/wp-content/uploads/2023/01/Non-Covered-Benefit-MNG-100_20230124.pdf Thanks to Central West Justice…

Mass. Health Care Training Forum Notice April 6 2022

MassHealth and Health Connector
This announcement distributed to the Mass. Health Care Training Form email list on April 6, 2022, describes several upgrades to the HIX Eligibility System including- A new option to allow people who will be eligible for ConnectorCare  with income of 150% FPL or less to check a box to be…

Unequal Housing Conditions And Code Enforcement Contribute To Asthma Disparities In Boston, Massachusetts

Evan Lemire, Elizabeth A. Samuels, Wenyi Wang, and Adam Haber
Housing quality is a primary determinant of asthma disparities by race and social class in the US. We sought to assess how housing code enforcement systems in Boston, Massachusetts, address tenants’ reports of asthma triggers. After adjustment for income and other neighborhood characteristics,…

March and Nov 2022 Upper Income Limits in MassHealth and Health Connector

MLRI
MassHealth updates its income standards with the current year's poverty level on March 1. Attached are tables from MLRI showing the upper income levels for MassHealth and Health Connector programs, updated to show the cost of living adjustments for 2022 that took effect in MassHealth…

Updated Office of Medicaid Guidance on Cuban-Haitian Entrants

Office of Medicaid
This Feb 2022 Eligibility Operations Memo from the Office of Medicaid provides information on how to identify Cuban-Haitian entrants who are "qualifed aliens" eligible for medical benefits on the same terms as US citizens. It updates an earlier June 2020 El Ops Memo to include examples of…

Update on Haitian Entrants

Misc
Feb 2022 UPDATED MassHealth Guidance on Cuban-Haitian Entrants https://www.mass.gov/doc/eom-22-03-eligibility-rules-for-cuban-and-haitian-entrants-0/download  Background Information on Newly Arriving Haitians Recently, hundreds of Haitian families, many with children, have arrived in…

Benefits Included in MassHealth by Coverage Type 2022

MLRI
Attached is a Table prepared by MLRI of the different kinds of services and service providers that are available under the various MassHealth coverage types described in MassHealth eligibility regulations & cross referencing to MassHealth fee for service regulations. It's been updated…

MassHealth Protection Notices During COVID-19

Office of Medicaid
This is a copy of the "protection notice" that MassHealth is sending out to certain beneficiaries who had been sent a renewal form, request for information or reported a change. It notifies them that they are still enrolled in their current coverage, not because they are eligible for it,…

ABCs of Seeking Judicial Review of a MassHealth Board of Hearings Decision

MLRI
Attached is an updated guide on the process of filing a complaint for judicial review of a MassHealth fair hearing decision. Please contact Kate Symmonds (ksymmonds@mlri.org) if you notice any errors or have any tips for other advocates; and please be sure to check the court rules and statutes for…

March & Nov 2021 Update of FPL Tables in MassHealth & Health Connector

MassHealth & MLRI
Attached are updated Tables from MassHealth and MLRI showing the upper income levels for MassHealth and Health Connector programs. It is updated to show the cost of living adjustments for 2021 that take effect in MassHealth programs on March 1, 2021. The Health Connector uses the 2020 federal…

State-funded Family Assistance and MassHealth Standard

Office of Medicaid
MassHealth Family Assistance provides coverage for different groups including 100% state-funded coverage for certain lawfully present and PRUCOL immigrants who are not eligible for federally reimbursed Medicaid. Until recently, Family Assistance included few long term services and supports.…

Health Benefits for Newly Arriving Afghans

MLRI
Massachusetts will soon be home to several thousand newly arriving Afghans. Most should be eligible for health coverage in MassHealth Standard or CarePlus. We have created this google doc to keep you abreast of the latest information we have to help new arrivals receive the correct…

IRS Stimulus Payments Never Treated as Assets

Office of Medicaid
This announcement from MassHealth clarifies that IRS Stimulus payments (also called Economic Incentive Payments or Recovery Rebates) are not income in the month of receipt and unspent funds will not be treated as countable assets for 12 months from receipt and for the duration of the federal public…

EOHHS v. Trocki Medicaid Estate Recovery Decision

Appeals Court
In this Aug 5, 2021 Appeals Court decision, the Court reversed the Superior Court's summary judgment in favor of EOHHS in a Medicaid estate recovery claim under G.L. c. 118E, Sec. 31 in which the claim consisted entirely of capitated monthly payments to a Senior Care Options (SCO) program.…

MassHealth Estate Recovery webinar for assisters & legal aid July 22, 2021

MLRI
MassHealth Estate Recovery A webinar for enrollment assisters & legal aid advocates July 22, 2021, 2-3 pm Recording & slides of July 22 Estate Recovery webinar now available. If you missed the July 22, 2021 Estate Recovery Webinar, the recording is posted here on the…

MassHealth Language Access Plan 2021-23

Office of Medicaid
Language Access Complaint Procedure A MassHealth consumer may file a complaint with the Agency Language Access Coordinator or the Office of Access and Opportunity if they believe they have been denied the benefits of this Plan. This complaint must be filed within six months of the alleged…

MassHealth Monthly Copay Caps

MassHealth
MassHealth mailed notices to members about a monthly cap on copayments beginning July 1, 2021 that will reduce the amount of copayments people with multiple prescriptions per month will have to pay.  However, the wording of the notice has led to widespread confusion with many people thinking…

MassHealth's May 2021 Changes to its COVID Continuous Coverage Protections

MLRI
Attached is a memo written by MLRI explaining MassHealth's guidance issued on May 4, 2021 describing certain changes in the continuous coverage protections in place during the federal public health emergency including advocacy that may be needed to protect some people from losing access to…

New Brokerage System for MassHealth PT-1 Nonemergency Transportation July 1, 2021

Office of Medicaid
MassHealth members in Standard, CommonHealth and CarePlus are eligible for non-emergency transportation assistance to get to and from their appointments with MassHealth providers if  they cannot use public transportation due to a disability or medical condition or because there…

MassHealth Estate Recovery

Office of Medicaid
MassHealth seeks to recoup the amount of money it has spent paying for services or paying managed care premiums on behalf of MassHealth members age 55 or older from the individual's "probate estate."  It also seeks to recoup the costs of nursing home care from the…

MassHealth estate recovery amended regulations

MLRI
MassHealth proposed changed to its estate recovery regulations in Jan. 2021.  Attached are the comments submitted by MLRI and 13 other organizations urging MassHealth to further expand its undue hardship criteria for waiving estate recovery and improve notice to MassHealth members and their…

1115 Demo amendment comments by 16 organizations

MLRI
In March 2021, MassHealth released for comment proposed amendments to the current 1115 Demonstration to among other things extend the  Medicare Savings Program higher income limits to CommonHealth members without an asset test and to extend the current period of 60 days post-partum…

1115 Renewal Recommendations on Eligibility & Access

MLRI, HLA and GBLS
MassHealth has operated under a comprehensive 1115 demonstration since 1997 affecting most of its member under age 65. The current Demo period expires in June 2022 and MassHealth  will be submitting a proposal to renew the current 1115 Demonstration for another 5 years in late spring/early…

What does the American Rescue Plan Act Mean for Affordable Health Coverage and Enhanced Medicaid services in Massachusetts?

MLRI
The American Rescue Plan Act (ARPA) signed by President Biden on March 11, 2021 is the most significant (albeit temporary) expansion of affordable health care coverage since the Affordable Care Act.  This Memo is a first pass at what the ARPA mean for affordable health coverage and…

Free or Discounted Broadband & Cell Phone Resources

MassHealth
This is a resource produced by MassHealth with help from the Dept. of Telecommunications that lays out in table form  resources available from many different Broadband and Telephone carriers for discounted or free service or devices including many temporary special offers related to…

Health Connector Updates- MA Health Care Training Forum Materials

Health Connector
Attached is a powerpoint presentation that the Health Connector presented at the July 2020 MA Health Care Training Forum (MTF) meeting regarding Health Connector updates. It describes the most recent COVID-19 related changes, the Health Connector's transition to a new customer…

July 23 MTF Announcement: 1. MassHealth Buy In & 2. Telephonic authorizations

MassHealth
This is an MTF announcement dated July 23, 2020 about two policy updates: 1. Correcting a system error affecting the Jan 1, 2020 expansion of the Medicare Savings Program (Senior Buy-In/Buy-In Programs). and 2. a June 29, 2020 change in policy authorizing applicants and members to complete a…

Filing a Pro Se Appeal from the MassHealth Board of Hearings

MLRI
Attached is a sample complaint appealing from a decision of the MassHealth Board of Hearings and an outline of key steps in filing an appeal with links to information on the Court's websites.  The Court website has information on filing an appeal from the decision of a state agency like…

Superior Court Decision Granting Hardship Waiver in Medicaid Estate Recovery Case

Judge Christine Roach
This was a Medicaid Estate Recovery case in which EOHHS was pursuing a reimbursement claim against the estate of a single parent who died at home leaving her disabled adult son living in the home along with the sister who had moved in after their mother's death. The family home was the only…

Assister Updates from MassHealth & Health Connector

MassHealth and Health Connector
MassHealth and the Health Connector issue regular updates via email to Certified Application Counselors and Navigators as Assister Updates that we will be posting from time to time. However, please check our Table of COVID-19 changes because some of these polices from Mar-May have changed over…

New Health Connector Mailing Address

Health Connector
On May 19, 2020 The Health Connector changed its mailing address. The new mailing address is Health Connector Processing Center, P.O. Box 4404, Taunton, MA 02780.  The MassHealth-Health Connector Mail/Fax Cover Sheet has been updated to reflect the new mailing…