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MassHealth 1115 Approved; More on Behavior Health; One Care Forum; Public Charge

Hello all, and happy Friday! 
 
Several important announcements below: 
1. MassHealth 1115 Demonstration Approved for Another 5 Years
2. More on Behavioral Health Discrimination
3. One Care Forum: October 6
4. Public Charge Final Rule
 
1. MassHealth 1115 Demonstration Approved for Another 5 Years: 
 
Key Documents posted by EOHHS: 

MassHealth has operated under a comprehensive 1115 Demonstration since 1997. On Sept 28, 2022 CMS approved an extension of the demonstration through Dec. 31, 2027. There are many new initiatives that will be rolled out over the next five years. Highlighted below are the main eligibility-related changes. More to come as we unpack other member-facing changes included in the Extension. 

MassHealth has 90 days to submit an implementation plan providing more details about the eligibility-related changes shown below including the effective dates.

 

  • Major expansion of CommonHealth coverage for adults with disabilities!
    • CommonHealth has no income or asset test but charges income-based monthly premiums. Currently CommonHealth is available for individuals with disabilities who are not financially eligible for MassHealth Standard and
      • are under the age of 19,
      • 19-64 and who have met a one-time deductible, or
      • 19 or older and working at least 40 hours per month.
    • Under the new demonstration Commonwealth will be available for individuals with disabilities who are not financially eligible for MassHealth Standard and
      • are under the age of 19, (no change)
      • 19-64 (NEW: no work restriction or one-time deductible)
      • 65 or older and working at least 40 hours per month, (no change) or
      • 65 or older and previously enrolled in CommonHealth for 10 years or more (NEW: no work requirement if previously enrolled for 10 years; to be implemented no later than July 1, 2023).
  • Continuous eligibility for individuals under 65 who are homeless or formerly incarcerated.
    • Once found eligible for MassHealth, continuous eligibility enables people to remain enrolled despite situations that would ordinarily lead to loss of coverage like increases in income or missing a paperwork deadline during the continuous eligibility period. The demonstration approves continuous eligibility for two groups
      • 12-months continuous eligibility for people re-entering the community from incarceration (including DYS facilities), and
      • 24-months continuous eligibility for people who have been confirmed as homeless for 6 months or more.
  • Making permanent 3-months retroactive eligibility for pregnant adults and for children under 19 by July 1, 2023
    • Federal Medicaid requires that eligibility date back up to 3 months from the date of application. Since 1997, CMS has allowed MassHealth to waive this provision and provide only 10 days of retroactive coverage for most people under age 65. During the COVID 19 pandemic, MassHealth reinstated 3-month retroaction coverage for everyone reminding us all how important this added coverage is to protect low-income people from medical debt. In its request for an extension, MassHealth only asked to waive 3-month retroactive coverage for non-pregnant adults 19-64 and, unfortunately, CMS once again approved this waiver. It did however require MassHealth to track how the retroactive coverage waiver affects medical debt and to document some measurable benefit associated with it.
  • Sunsetting Medicaid payment of Medicare Part B premiums for individuals enrolled in CommonHealth starting in Dec 31, 2025.
    • The demonstration had authorized payment of Medicare Part B premiums for CommonHealth members with income over 133% but not over 135% of poverty without applying an asset test. In June 2021, MassHealth filed an amendment seeking to pay Part B premiums for CommonHealth members with income up to 165% of poverty in accordance with state legislation expanding these Medicare Savings Programs on Jan. 1, 2020. (On Jan 1, 2023, state legislation is expanding MSP to 225% of poverty). CMS not only failed to approve that amendment request, but it also set a deadline for phasing out payment of all part B premiums in CommonHealth after June 30, 2026. This was a surprise and is apparently related to a change in CMS’s interpretation of a federal statute at 42 USC 1395v.
    • On Aug 22, 2022 CMS approved the June 2021 request to allow the state to pay Part B premiums for MassHealth Standard members with incomes from 135- 165% FPL without an asset test. 
 
2. Additional Material on Medical Discrimination:
 
We had a great Health Care Working Group meeting this week, thanks to all who attended and participated in the discussion, and special thanks to our presenters: Wells Wilkinson (HLA), Suzanne Curry (HCFA), Jennifer Thompson (Advocates), Catherine Ady-Bell (CWJC), and Kara Hurvitz (HLA)!
 
During our conversation about medical discrimination, Kara mentioned a helpful resource from the Mental Health Legal Advisors Committee (MHLAC). As promised, here it is (see attached), with some contextual information: 
 
"When the Doctor Discriminates" is a brochure written for clients. Some additional information to tell clients includes: 
  • If you have MassHealth, you can file a complaint with the MassHealth plan you're enrolled in, as well as with MassHealth itself. It is a good idea to first contact MassHealth's My Ombudsman at (855) 781-9898 to see what help they can offer. 
  • If a hospital or its staff discriminates against you, you can file a complaint with the hospital's Office of Patient Advocacy. Other types of provider groups may have their own internal complaint procedures. 
  • You can file a complaint against a doctor with the Bureau of Health Professions Licensure: https://www.mass.gov/how-to/file-a-complaint-with-the-bureau-of-health-professions-licensure  
  • You can also file a complaint with the Office of Civil Rights based on federal disability discrimination law, like the Americans with Disabilities Act: https://www.hhs.gov/civil-rights/filing-a-complaint/complaint-process/index.html 
 
3. EOHHS Holding One Care Stake Holder Forum on Oct 6, 2022

 

The Executive Office of Health and Human Services (EOHHS) invites all interested parties and members of the public to join an Open Public Meeting to discuss the initial Transition Plan to move One Care from a demonstration to a more stable federal status. EOHHS looks forward to robust stakeholder engagement as well as collaboration with the Centers for Medicare & Medicaid Services (CMS) to fully develop the Transition Plan.

 

The initial Transition Plan lays out the process EOHHS expects to use to determine the structural, policy, and operational elements of its Transition. This plan will be considered a living document that will be updated and expanded based on the feedback received from stakeholders and CMS. EOHHS is committed to an engagement process with a wide array of stakeholders to promote collaborative discussion on the planning and implementation as it begins its transition planning process.

 

In the Open Meeting, EOHHS will provide an overview of the stakeholder engagement process to develop the Transition Plan, as well as an overview of key issues and questions that will need to be processed in order to determine the direction and shape of the Transition. We look forward to feedback and discussion as we begin this process.

 

For reference, please find EOHHS comments submitted to CMS on the proposed rule on March 7, 2022.

 

Topic: One Care Stakeholder Forum - Transition Plan

Time: Thursday, Oct 6, 2022 02:00PM Eastern Time (US and Canada)

 

Join from PC, Mac, Linux, iOS or Android: https://umassmed.zoom.us/j/95375186933?pwd=dnhmekdDV3dOUzBHMkdhWXEvL1JaZz09

Password: 539849

 

 

4. Public Charge Final Rule published Sept 9, 2022

 

On Sept 9, 2022, USCIS published the final public charge rule which will apply to applications submitted on or after the Dec 23, 2022 effective date. 87 Fed Reg 55472-638. Until then the 1999 Field Guidance will apply. The final rule is essentially the same as the 1999 Guidance but with some helpful clarifications. The national Protecting Immigrant Families (PIF) coalition has put out flyers in multiple languages with basic information about public charge for community members and a 2-page fact sheet for advocates here. More Massachusetts-specific materials from PIF-MA are coming soon.

 

The final rule, like the 1999 guidance, only considers two kinds of benefits in the public charge test: Cash assistance for income maintenance like SSI, TAFDC & EAEDC, and long-term institutionalization at government expense. Health programs like MassHealth are only considered if they paid for long-term institutionalization. 

 

In Massachusetts, long-term care in a nursing home or chronic disease and rehabilitation hospital is covered by MassHealth for both federally eligible immigrants and, since November 2021, for lawfully present and PRUCOL immigrants who are not federally eligible. Other government-funded institutions may include the four specialty hospitals operated by the Dept of Public Health, the Chelsea and Holyoke Soldiers’ Homes, and the four continuing care facilities operated by the Dept. of Mental Health.  

 

The actual public charge regulations are on pages 55636-8 and define long-term institutionalization at 8 CFR 212.21(c) as:

 

Long-term institutionalization at government expense means government assistance for long-term institutionalization (in the case of Medicaid, limited to institutional services under section 1905(a) of the Social Security Act) received by a beneficiary, including in a nursing facility or mental health institution. Long-term institutionalization does not include imprisonment for conviction of a crime or institutionalization for short periods for rehabilitation purposes

 

The preamble section defining long-term institutionalization is on pp. 55530-8. It says USCIS will be working with HHS to produce sub-regulatory guidance to distinguish long-term from short-term institutional care. The preamble also explicitly says that home and community-based services (the kind of services that help people avoid institutional care) are NOT considered institutional care, and that the test will take into account whether someone was wrongly institutionalized in circumstances where less restrictive home and community-based services were required.   

 

Importantly, the preamble also states that USCIS will be designing new questions for the Form I-485 (Application to Register Permanent Residence or Adjust Status). The planned revisions (described on pp 55576-7) will ask if the applicant is subject to public charge, and, if not, let the applicant skip the benefit questions. The benefit questions will also be revised. Instead of asking if the applicant ever received a public benefit as it does now, the form will ask about receipt of only the designated benefits (cash assistance for income maintenance and long-term institutionalization at government expense). This should go a long way in getting the message out about the limited scope of the public charge rule.

 

File Attachment: