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MassHealth Eligibility and Enrollment Update

Apologies for the long post, a lot is happening in the world of eligibility and enrollment in MassHealth and ConnectorCare. As always please let Neil Cronin or Vicky Pulos at MLRI know how these changes are affecting your clients.

Four new enrollment events in Jan and Feb 2016: in person help from MassHealth and Connector staff to apply, re-apply and enroll in Worcester, Dorchester, Hyannis and Malden


1.  Open Enrollment ends Jan. 31, 2016.

Most people in ConnectorCare (and with other coverage through the Connector) were automatically redetermined and renewed into the same plan as last year. Jan. 31 is the last date for these enrollees to change plans without cause. It is also the last date for people who need to buy individual coverage for themselves to do so without having experienced a qualifying event. More information is on the Connector website:

2.  MassHealth reapplication/renewals continue.

MassHealth is continuing the process of requiring current members to renew by reapplying using the online application or ACA-3 application form. Renewing members will get a new determination based on a new income methodology that took effect Jan. 2014. MassHealth started with 1.2 million to renew, and has been sending out reapplication notices in waves since Jan. 2015.

  • As of August 2015, of 500,000 members required to reapply in the first half of the year: about 300,000 reapplied and were still eligible for MassHealth, about 43,000 reapplied and were eligible for ConnectorCare, about 140,000 did not complete a reapplication by the deadline and were terminated (the others were eligible for unsubsidized Connector plans or no longer eligible for any subsidized plan).
  • As of Dec 26, 2015
    • 61,000, including people with disabilities, were required to reapply by 10/16/15. About 35,000 reapplied and were found eligible for MassHealth, 12,000 did not reapply and were terminated and another 9,000 are still pending.
    • 22,700 were required to reapply by 11/4/15. About 65,000 reapplied and were still eligible for MassHealth, about 5,000 were eligible for ConnectorCare, 36,000 failed to reapply and were terminated, 10,700 are still pending.
    • 36,000 including people receiving premium assistance were required to reapply by 12/10/15, 4,000 reapplied and were still eligible for MassHealth, 21,000 failed to reapply and 10,500 are still pending.
  • Up next
    • About 20,000 more people were notifed 12/4/15 of a 1/18/16 deadline to reapply
    • About 84,000 (est. as of 12/16/15) are scheduled to be notified 1/15/16 of a deadline to reapply by 2/19/16. This will include about 70,000 (or less) who were renewed based on SNAP eligibility in past and 12,000 individuals with MassHealth Limited.

What do these numbers mean? Hard to know.

Some people losing coverage may have last applied/renewed as far back as Oct 2012 and may no longer need coverage in Massachusetts. Some of the drop off may reflect duplicate coverage. Many people who do need coverage are probably being assisted to reapply €“with same day determinations possible in the on-line system, 10 days retroactive coverage, and no tax penalty for being uninsured for less than 2 months in the year (federal) or 3 months in the year or if income under 150% FPL (state), they may be OK.

And enrollment numbers are always dynamic. As of Nov. 30, 2015, MassHealth enrollment data shows total enrollment has dropped by less than 75,000 compared to Feb. 28, 2015 (a date before the first of the renewal terminations took place in April 2015).

3. MassHealth terminations for failure to return required verification begin:

For people who applied or reapplied in the new system after November 2014, the system attempts to verify their income and other eligibility factors through a data match with other sources. If the data is not available or not consistent with information on the application, the individual is found eligible based on the self-declared information and notified to submit documentary proof as verification. Due to various system related limitations, and a backlog processing paper verification, MassHealth is only now starting the process of terminating individuals who were notified to submit proof of income and failed to do so.

As of mid-October there were about 100,000 people enrolled in MassHealth who had not submitted proof of income by the deadline. MassHealth plans to send out notices in waves. It started in late December and anticipates continuing into March. If there was data available (but not consistent with info on the application), they will make a new decision based on the electronically verified income data. Their only source of income verification currently is past tax returns. If there was no income info available from a past return, people will get a 14 day advance notice of termination. The notice will say the reason for termination is missing proof of income and that MassHealth will make a new eligibility decision if sent current income verification. In the first group about 11,000 were terminated and about 12,000 got a new eligibility decision.  Remember, these notices are appealable, and appealing before the termination date is the only way to guarantee that there will be no break in coverage.

4. Job update forms for some people who reported no income.

In January MassHealth is planning a new process to check people who reported no income against the DOR new hire and quarterly wage data files. If DOR shows recent income, MassHealth will send out a job update form that must be returned in 30 days explaining the discrepancy. Failure to return the form by the deadline will result in a termination notice.

5. MassHealth Managed Care:

  • Health New England, a health plan operating in Western Mass., is dropping out of MassHealth CarePlus but will retain its other MassHealth members. CarePlus members enrolled in HNE were notified they have until Jan. 29 to choose a new plan; those who make no choice will be automatically enrolled in the Primary Care Clinician (PCC) Plan. Members of the PCC plan can see any participating MassHealth provider for medical care, will need a referral from their primary care clinician for some services, and receive behavioral health through the Partnership (MBHP). CarePlus members can change plans at any time but the change will only take effect on the first of the following month.
  • Tufts Health Plan is no longer using Network Health in the name of its MassHealth and Connector Care Managed Care plans. Its MassHealth plan is called Tufts Health Plan Together and its ConnectorCare plan is called Tufts Health Plan Direct. Unlike most of the other MassHealth and ConnectorCare MCOs, Tufts does not have the same providers available in its public plans as in its commercial plans. This is likely to cause confusion for enrollees who picked Tufts because their provider said they accept it but in fact only accept the Tufts commercial plans not its public plans.