Medicare/ Medicaid Dual Eligibles

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…

JAN  2025 UPDATE: CMS notified MassHealth that CommonHealth members who qualify for Medicare Savings Programs should get both and approved a 1902(e)(14) waiver to enable MassHealth to comply pending necessary system changes.  MID-NOVEMBER 2024 UPDATE: We understand that after…

MassHealth has started posting fair hearing decisions on its website. As of February 2024, there are over 2400 decisions from July -Sept 2023 currently posted with a filtering feature by topic. 

Attached is a complaint for judicial review and declaratory judgment in an appeal from an adverse decision by the Board of Hearings. The case involved the failure of MassHealth to implement the Jan 1, 2023 expansion of the income eligibility criteria for Medical Savings Programs for people who…

The link below with information about One Care, MassHealth + Medicare for individuals with disabilities, now includes a Table comparing features of One Care and SCO. After turning 65, people on MassHealth Standard who are enrolled in One Care  have a choice of remaining in One Care or enrolling…

CMS approved a state plan amendment to increase the income disregard in the Medicare Savings Programs to 90% FPL effective Jan. 1, 2023.  MassHealth issued an EOM in Feb followed by emergency regulations with a comment period in May 2023. Attached are the comments of MLRI and 14 other legal…

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…

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…

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…

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…

The Disability Policy Consortium has a contract with MassHealth to operate an Ombudsman program to assist MassHealth members having problems with their managed care plans. It was originally created to help people in One Care, an integrated managed care program for individuals with…

This website contains materials related to the Office of Medicaid proposal to integrate services for individuals under age 65 dually eligible for Medicare and Medicaid. It includes links to the recent Memorandum of Understanding signed by the state and federal governments regarding the…

Letter from Disability Advocates Advancing our Health Care Rights (DAAHR), a broad-based disability rights coaltion initially organized to work on the Office of Medicaid's proposal to integrate services for people under age 65 dually eligible for Medicaid and Medicare, to Sec. Bigby and …

In July 2009, the MassHealth agency notified thousands of CommonHealth recipients that MassHealth would no longer pay for their Medicare Part B premiums. This flyer explains what happened and what options are available to those affected by this change.

Fact Sheet on appeal rights in the Medicare Drug program. Prepared by the Medicare Advocacy Project.

Medicaid Office publication for pharmacies describing state assistance for MassHealth members with Medicare drug coverage: up to 72-hour emergency supply of drugs if Medicare drug plan doesn't pay & copay subidy so copays do not exeed $1 for generic $3 for brandname plus Medicare "point of…

Flyer entitled "My Medicare Drug Plan Won't Pay for My Drugs, What Can I Do?" in English & Spanish prepared by Medicare Advocacy Project