MassHealth & Connector Renewals & MassHealth Coverage Policy Changes

Renewals for People with Disabilities Underway-Workaround needed for some adults

About 36,000 households with at least one member with a disability were notified on August 1 of the need to reapply by September 15.  The new eligibility & enrollment system (HIX) is able to make the correct eligibility decision for disabled children eligible for Standard or CommonHealth. It has more limited functionality for adults. It can find disabled adults eligible for Standard who have regular MAGI at or under 133% of poverty. It cannot make correct determination for disabled adults who have income over 133% of poverty who are either still eligible for Standard under special income-counting rules that are different from the regular MAGI rules or who are eligible for or subject to a spenddown in CommonHealth. 

There is a workaround for these individuals but HIX noticing will be confusing & we don't yet know how well the workaround is working. Attached is a paper by MLRI to help advocates understand the workarounds. Please let us know if you are seeing problems for disabled individuals who are required to reapply. Email: vpulos@mlri.org or ncronin@mlri.org But remember most disabled individuals are NOT required to reapply including disabled adults NOW on CommonHealth.

Next Up: Notices going out 9/1 to reapply by 10/16.

Next up is a large group of over 65,000 households now on MassHealth Standard, Family Assistance or CarePlus, including former TAFDC families, who were not included in the March-April mailing . Notices to reapply will be going out to them on Sept. 1 to submit applications by Oct. 16. 

MassHealth has scheduled 5 enrollment events in Dorchester, Lawrence, Brockton, E. Boston, & Holyoke starting in mid-September to help people complete their reapplications by the October deadline A flyer with the dates, times & locations of these events is attached.

2. The Connector gets into the act on Renewals.

About 170,000 people are now enrolled in ConnectorCare (125,000) or other Connector coverage (45,000) for 2015. Their eligibility must be redetermined for 2016 and they will be able to make new plan choices for 2016 during the next open enrollment period. Unlike MassHealth members, everyone insured through the Connector is already in the new HIX computer system. This enables the Connector to streamline the process for its renewing members. Its plan is to use information submitted for 2015 to automatically determine eligibility for 2016 (with some automated updates to reflect data reports of death, disability and receipt of public insurance, updated 2015 poverty level guidelines & any changes reported by members), and to automatically "map" members into the 2016 plans most like their plan choice in 2015 unless the member makes a different choice during open enrollment.

In late August/early September, the Connector's redetermination and renewal process begins with a Preliminary Notice letting people know what the Connector intends to use as the member's income & family size for 2016 (based on the 2015 application) & giving the member a chance to update any information that has already changed in 2015 or is expected to change in 2016.  People who created on-line accounts at mahealthconnector.org will be able to make changes themselves to their online account for 2015, 2016 or both. If there are no changes to report, current Connector enrollees do not need to take any action in response to the Preliminary Notice.

In September the Connector board will be selecting the plans available in 2016 including the ConnectorCare plans. In October, a Final Notice will go to renewing members letting them know what plans are available, what the premium charges are, which plan they will be enrolled in if they do nothing, and how to select a different plan from the "mapped" plan. Open enrollment for 2016 coverage will start on Nov. 1, 2015 and end Jan. 31, 2016. 

Premium-paying members will need to continue paying premiums throughout this process. 

The July MassHealth Training Forum ACA Learning Series included a presentation on the Connector Redetermination and Renewal Process posted here: https://www.masshealthmtf.org/sites/masshealthmtf.org/files/ACA%20Learning%20Series_revised%207.20.15.pdf

3. New billing and reimbursement policy for emergency services in MassHealth Limited.

MassHealth has released a Provider Bulletin describing changes in the claiming process for MassHealth Limited. Limited covers only emergency services for individuals ineligible for Standard or CarePlus based on their immigration status. According to MassHealth, these changes are intended to better document the emergency nature of the services not to change current coverage. It has always been hard to know exactly what Limited will cover since there are no regulations or provider manuals that spell out  exactly what services are covered in terms of procedure codes or similarly detailed information. This doesn't appear to be changing. However, under the new policy, if payment is denied, a provider will be able to resubmit the bill with certification of the emergency.

All Provider Bulletin 251 (August 2015) is posted here: https://www.mass.gov/files/documents/2016/08/sx/all-251.pdf

4. Augmentive and Alternative Communication Devices: Tablets Now Covered.

MassHealth has a new policy on AAC devices for people with certain communication disorders. MassHealth will now cover tablets that have been "medically configured" to be used only for communication purposes as durable medical equipment. Such devices are covered now for children and youth under 21. Later these devices will be available to adults as well. A lot of documentation of medical necessity is required. See the current AAC regs at 130 CMR 409.428. A short announcement of this policy is posted on the MassHealth Training Forum website here: https://www.mass.gov/files/documents/2016/07/oz/mng-aac.pdf