Health Announce-Update May 13, 2021
1. May 9, 2021 MassHealth resumes annual renewals with protections still largely in place
Since March 2020, MassHealth has generally suspended all but administrative renewals. In May 2021 it is resuming annual renewals in accordance with pre-COVID procedures, but importantly, coverage is still protected by the maintenance of effort/continuous coverage provisions of the Families First Coronavirus Response Act (FFCRA) that, with only limited exceptions, applies to people enrolled in Medicaid on March 18, 2020 or later during the public health emergency.
MassHealth has released a document describing its plans to resume renewals and to make certain changes in coverage pursuant to November 2020 final rules interpreting the FFCRA provision for maintaining coverage. It has also developed a protection notice that lets members know that they are remaining in their current coverage but only due to the protection which is expected to be in place at least through Dec 2021. We have posted the MassHealth Eligibility Update and the Protection notices here: https://www.masslegalservices.
Changes beginning in May 2021
· Starting on May 9, 2021, MassHealth is resuming the renewal process. It has a backlog of about 314,000 renewals in both HIX (265,000) and MA-21 (45,000) that could not be administratively renewed (renewed into same coverage based on data matching). It plans to begin with smaller weekly mailings to monitor progress and make changes as needed.
· No one will lose Medicaid coverage based on the renewal during the public health emergency (PHE), but some people may move to less comprehensive benefits such as a low income parent whose youngest child turns 19 moving from MassHealth Standard to CarePlus. We have been assured that CarePlus-eligible members enrolled in Standard based on “medical frailty” will be protected in Standard. CarePlus members who have turned 65 and enrolled in Medicare who were upgraded to Standard via the “workaround” needed for MassHealth to be secondary to Medicare will also remain protected in Standard.
· MassHealth also plans to return to the practice in place before the PHE of reducing Health Safety Net (HSN) coverage to only dental services 90 days after people eligible for ConnectorCare are also found eligible for HSN. It had suspended application of this rule in March 2020. See below for more about changes in ConnectorCare coverage that may enable more of the 241,000 people eligible for ConnectorCare but unenrolled to afford coverage and sign up.
· Meanwhile, MassHealth will continue redeterminations for previously CHIP-funded new mothers and 19 year olds without protecting their previous non-Medicaid coverage, a practice it resumed in the summer of 2020.
To some extent this is a "safe" preview--with protections still largely in place-- of what we may see in 2022 after the public health emergency and the protection have ended. We need your help to monitor how this is working to flag issues that need to be fixed before 2022.
MLRI will be distributing a memo soon with advocacy tips and policy issues related to these changes and to the redeterminations for the previously CHIP-eligible new mothers and 19 year olds.
2. Health Connector Continues Implementing American Rescue Plan Act Expansion of Eligibility for Low Cost Health Coverage
The American Rescue Plan enacted in March 2021 made low cost coverage available through the Health Connector more affordable for more people in 2021 and 2022. The Health Connector has done an extraordinary job of gearing up to reduce premium costs for their current enrollees, and to get the word out to those who are newly eligible for low cost coverage.
In April, the Health Connector redetermined eligibility for approximately 183,000 existing enrollees with incomes under 400 percent FPL in order to lower their premiums on May 1, 2021. Average savings ranged from 7 to 55 percent, with enrollees in Plan Type 2A with income between 150-200 percent averaging 55 percent lower premiums.
In late April & May it also redetermined eligibility for approximately 241,000 people who had previously been found eligible for ConnectorCare but hadn’t enrolled. With lower premiums, more may be able to enroll on May 1 or June 1, 2021.
In May the Health Connector redetermined eligibility for enrollees with income over 400 percent FPL who had applied for help with costs but hadn’t qualified until the ARP eliminated the 400 percent income cap for 2021 and 2022.
Starting in June, it will be able to redetermine eligibility for enrollees with reported unemployment income in 2021 who are now eligible for coverage with no premium charge starting in July 1, 2021.
It has also ramped up an ambitious outreach and enrollment campaign in cooperation with DUA, DOR, community groups, private insurance companies and its communications vendor to get the word out to eligible individuals.
3. May 11, 2021 Senate Ways & Means Releases Its Budget
It’s budget season! MLRI’s preliminary analysis of selected issues in the SWM Budget for FY 22 is posted here
4. May 12, 2021 Applications Open for the FCC’s Temporary Emergency Broadband Benefit (EBB)
As of May 12, 2021, eligible households will be able to enroll in the program to receive a monthly discount off the cost of broadband service from an approved provider. Eligible households can enroll through an approved provider online or by mail. There is a consumer-friendly summary of the program including eligibility, benefits, links to approved providers in Massachusetts and the online application here: https://www.masslegalhelp.org/
5. May 14, 2021 Final Medicaid Estate Recovery Rules are effective
MassHealth released proposed Medicaid Estate Recovery regulations for comment in January 2021. MLRI and 15 other organizations submitted written comments commending the changes, making recommendations for more changes and pointing out the need for added legislative reform. The final rules were published in May with a May 14, 2021 effective date. Eligibility Letter 238: Revisions to Estate Recovery Requirements
The final regulations are a vast improvement over the old regulations which had not been significantly amended since 2003 when the single ground for a hardship waiver was made more restrictive. The final regulations exempt estate recovery for probate estates with total value of $25,000 or less which according to MassHealth represent over 50 percent of claims filed but just 4 percent of the amount recovered. This provision in the final rule is effective for dates of death after May 14, 2021, but the policy has been in place since the COVID-19 public health emergency and is described in a November 2020 policy update.
The final regulations also make significant improvements to the rules for waiving estate recovery based on undue hardship to the heirs. The new hardship rules apply to MassHealth notice of claims presented on May 14, 2021 or later. It eliminates the two year conditional period before a waiver is granted under the prior single ground for a hardship waiver and adds two new grounds for waivers based on hardship. One new waiver would protect the house based on hardship to a caregiver who had lived with and cared for the MassHealth member for at least two years prior to a nursing home admission or death, and another new waiver would enable heirs with income of 400 of the poverty level or less to inherit a certain dollar amount free of the MassHealth recovery claim.
The agency has also created a new Massachusetts Medicaid Estate Recovery website with more information about the process including a set of FAQs, and a link to the new rules.
The final rules adopt several of our recommendations with respect to the agency’s proposed amendments, but reject all our recommendations for added grounds for hardship or for requiring better notice in the regulations. Pending legislation would both limit estate recovery in ways that can only be accomplished by legislation and provides for added grounds for hardship and better notice as we recommended to the agency. An Act Protecting the Homes of Seniors and Disabled People on MassHealth, Senate Bill 79 (Sen. Comerford) and House Bill 1246 (Rep Barber).
6. On May 10, 2021 U.S. DHHS Affirms Prohibition on Sex Discrimination Includes Discrimination on the Basis of Sexual Orientation and Gender Identity
The U.S. Department of Health and Human Services announced that the Office for Civil Rights will interpret and enforce Section 1557 and Title IX’s prohibitions on discrimination based on sex to include: (1) discrimination on the basis of sexual orientation; and (2) discrimination on the basis of gender identity. Section 1557 prohibits discrimination on the basis of race, color, national origin, sex, age, or disability in covered health programs or activities. The update was made in light of the U.S. Supreme Court’s decision in Bostock v. Clayton County and subsequent court decisions.