Health Announce: June 17, 2025

Topics for this week’s Health Announce:

1. Medicaid Defense: Worse Cuts to Medicaid in Senate Finance Committee’s draft of OBBBA
2. Mandatory Medicare Enrollment at Age 65 EOM posted.
3. Uncertain future for MassHealth’s plans to increase asset limits and life insurance policy limits.
4. Temporary Authorized Representative Designee to be discontinued as of June 30, 2025
5. Update to MassHealth Estate Recovery Policy Under the LTC Act.
6. Primary Care Referrals again required for Orthotics and Prosthetics Services.

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This week, we observe Juneteenth, the day 160 years ago when the last slaves in the US were freed – more than two years after the Emancipation Proclamation. An official state holiday since 2021, Juneteenth celebrates African-American freedom and achievement. You can attend several free Juneteenth commemorations across the state, such as those at the Boston Museum of African American History, Old Sturbridge Village, Springfield Symphony Orchestra, and more.

Be well,

Health Law Unit
Massachusetts Law Reform Institute

1. Medicaid Defense: Worse Cuts to Medicaid in Senate Finance Committee’s draft of OBBBA

Last night the Senate Finance Committee Federal released its draft of legislative text for the Senate’s version of the One Big Beautiful Bill Act – and its proposals contain more severe cutbacks to Medicaid. Some of the lowlights include:

• Expands the House’s Medicaid work requirement from single individuals between 19 and 64 to include adults with dependent children over the age of 14 (Sec. 71124. Requirement for States to Establish Medicaid Community Engagement Requirements for Certain Individuals)
• Penalizing Medicaid-expansion states by capping provider taxes at 3.5% by 2031, down from its current limit of 6%. Non-expansion states would have provider taxes frozen at current levels (Sec. 71120. Provider Taxes)
• Cuts some state-directed payments to hospitals, which will hit rural hospitals the hardest (Sec. 71121. State Directed Payments)
• Eliminates Medicaid and CHIP eligibility for certain legal immigrants, including refugees, asylum seekers, certain abused spouses and children; certain victims of trafficking; limits eligibility to Lawful Permanent Residents (after a 5-year or longer waiting period); certain Cuban immigrants; and individuals living in the United States under a Compact of Free Association (CoFA), and lawfully residing children and pregnant people in states that opt to provide coverage for them (Sec. 71110. Alien Medicaid
  Eligibility)
• Reduces the federal medical assistance percentage (FMAP) for “emergency only” services provided to low-income adults who, because of their immigration status, are ineligible for full scope Medicaid, shifting the costs of federally-mandated care to states (Sec. 71112. Expansion FMAP for Emergency Medicaid)
• Eliminates Medicare eligibility for certain immigrants, such as refugees, asylum seekers, and victims of human trafficking. (Sec. 71201. Limiting Medicare Coverage of Certain Individuals)

In sum, the Senate took the already-awful House version of the bill – with its negative changes to enrollment processes and destructive cuts to the Medicare Savings Program, to name a few – and made it worse.

Coverage of the Senate Finance Committee Federal legislative text for the OBBBA:

• Politico, Senate GOP rethinks tax cuts, Medicaid overhaul in Trump’s megabill
• The Hill, Here’s what’s in the Senate GOP’s version of Trump’s “big, beautiful bill”
• AP, Senate Republicans seek tougher Medicaid cuts and lower SALT deduction in Trump’s big bill

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2. Mandatory Medicare Enrollment at Age 65 EOM posted.

In January 2025, MassHealth described its plans to implement a cost-savings initiative to require older adults on MassHealth Standard to enroll in Medicare as a condition of maintaining their MassHealth coverage in FY 2026. This initiative will affect approximately 15,000 older adults, three-fourths of whom are non-citizens. It couldn’t come at a worse time given the staffing cuts and delays at SSA offices and the many negative actions of the federal government targeting the immigrant community and spreading fear. Nonetheless, MassHealth is moving forward with it.

This week, MassHealth issued Eligibility Operations Memo 25-10, Mandatory Medicare Enrollment at Age 65, summarizing the policy, describing the outreach, and explaining the process.

We think most of the people affected by this initiative do not have Medicare now because they do not have the work credits to qualify for Social Security Retirement benefits and premium free Medicare Part A. This is a problem for citizens and non-citizens alike when going to SSA to apply for Medicare because, without QMB, they can’t enroll outside of open enrollment, may face late enrollment penalties, and will be charged a premium of $518 per month for Medicare Part A in addition to the Medicare Part B premium of $185 per month. QMB is the solution to this problem, but only if SSA and MassHealth are communicating with one another.

In addition to the problems all MassHealth beneficiaries have without premium free Medicare Part A, non-citizens face more problems because some non-citizens who are eligible for MassHealth Standard will not be eligible for Medicare. As far as we know, MassHealth is assuming any older adult on MassHealth Standard with income of 190% FPL is eligible for QMB without screening out those non-citizens who are not eligible for Medicare.

We anticipate a lot of problems when the initial outreach notices start going out in July. The first terminations could be as early as September. (Earlier notices sent out by PACE, SCO Plans, and nursing homes will not lead to terminations, just the notices from the UMass Medicare Enrollment Support Project). We've posted a sample of the UMass outreach notice and other info on MLS.

Please be on the lookout for clients receiving these outreach notices and let Vicky (vpulos@mlri.org) know what your clients are experiencing with UMass and SSA.

3. Uncertain future for MassHealth’s plans to increase asset limits and life insurance policy limits.

The Governor’s budget filed in January contemplated certain new policies as part of the MassHealth allocation request, including improving eligibility for seniors by increasing the asset limits and raising the exemption limit for whole life insurance. Specifically, MassHealth intended to increase the asset limit to $5,000 for individuals and $7,500 for couples, as well as raise to $10,000 the exemption limit for whole life insurance. Given the uncertainty and unpredictability at the federal level regarding Medicaid funding and how that has impacted the state’s budget process, these policies are on hold. Originally planned to begin in July of this year, MassHealth is reassessing whether these policies will advance at all.

4. Temporary Authorized Representative Designee to be discontinued as of June 30, 2025.

To support states at the end of the COVID public health emergency, the Centers for Medicare and Medicaid (CMS) allowed states to request time-limited authority under section 1902(e)(14)(A) of the Social Security Act to implement specific strategies to help during the unwinding. MassHealth sought and was approved for one such E14 waiver to permit MassHealth applicants and members to verbally designate an
authorized representative over the telephone for the purpose of singing an application or renewal form, without requiring a signed designation. Certified Application Counselors (CACs) found this temporary Authorized Representative Designee (ARD) authority very valuable in working with individuals who were unable to meet with them in person.

As of June 30, 2025, the E14 wavier authority for temporary ARDs ends. A new eligibility operations memo (EOM) will issue soon that should review policies for electronic and telephonic signatures that remain in place. Advocates are continuing to explore other options to make it easier for CACs to complete applications over the telephone for people who cannot get into their offices and don't have internet access.

5. Update to MassHealth Estate Recovery Policy Under the LTC Act.

In May, MassHealth posted EOM 25-09, Updates to the MassHealth Estate Recovery Policy Under the LTC Act. The Act to Improve Quality and Oversight of Long-Term Care (the LTC Act), signed into law in September 2024, required MassHealth to reduce its estate recovery activities to only what is required under federal law. The change took effect for anyone who died on or after August 1, 2024, and the EOM acknowledges the changes. Relevant regulations at 130 CMR 501.000 and 130 CMR 515.000 still need to be updated in the future.

6. Primary Care Referrals again required for Orthotics and Prosthetics Services.

Effective as of August 1, 2025, MassHealth is reinstating referral requirements for orthotics and prosthetics services provided to members in the Primary Care Clinician (PCC) Plan and for the Primary Care Accountable Care Organizations (ACOs). As provided in 130 CMR 450.118(J) and 130 CMR 450.119(I), claims for orthotics and prosthetics services provided on and after August 1, 2025, must include an authorized referring provider. (See All Provider Bulletin 403.)