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Advocates' Comments on Proposed MassHealth Eligibility Regulations 8.1.25

MLRI, HCFA and HLA
Attached are comments by MLRI, HCFA and HLA on proposed amendments to 10 sets of MassHealth regulations. Many of the changes are bringing the regulations up to date to reflect policies amended as far back as 2022 through Eligibility Operations Memos. This includes the amended regulations on…

Summary of MassHealth estate recovery changes in 2024

MLRI
In September 2024 the MassHealth estate recovery statute at GL 118E: 31 was amended. The new law  takes effect Dec 5, 2024 and applies retroactively to the probate estates of MassHealth members who die after August 1, 2024. It reduces the scope of estate recovery to only what federal law…

Mandatory Medicare Enrollment at age 65

MassHealth
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 10,800 older adults, three-fourths…

State-funded Family Assistance and MassHealth Standard for Immigrants

Office of Medicaid
June 2025 Update: MassHealth released a series of provider bulletins reflecting the May 2025 change in eligibility for state-funded MassHealth Standard for certain immigrants:Open PDF file, 242.77 KB, Acute Inpatient Hospital Bulletin 204: Discharge Planning to Support Certain Family Assistance…

Elder Benefits Programs -- BBT Training

CLA, DLC, GBLS, MLRI, GSSSI
Materials from the April 17, 2025 Elder Benefits training, presented as part of the MLRI/MCLE Basic Benefits Training Series: About the Faculty Presentations Elder Basic Benefits Training: Additional resources for older adults (pdf of slides) Elder Basic Benefits Training: Medicare…

Immigrants and Public Benefits -- BBT Training and Resource Materials

MLRI
The following are materials are for the March 19, 2025 Immigrants and Public Benefits training. These are the core materials presented as part of the annual Mass Law Reform Institute and Mass Continuing Legal Education Basic Benefits Training (BBT) Series. We've also added some additional…

Health Benefits for All Massachusetts Residents Regardless of Citizenship

MLRI
A list of health programs available to all Massachusetts residents regardless of US citizenship or immigration status with a short description of each program and information on how to apply; in English, Spanish & Portuguese. Revised in March 2025 with updated information about CMSP which now no…

Understanding immigrants' eligibility for MassHealth & other subsidized coverage, March 2025

Vicky Pulos, MLRI
This  updated March 2025 memo summarizes the current immigrant eligibility rules that MassHealth and the Health Connector use in making decisions about what kinds of coverage non-citizens with different kinds of status can receive.It includes Appendices listing different…

MLRI's Health Program Upper Income Limits Table-updated for 3.1.25

MLRI
Attached is MLRI's March 1, 2025 Table of monthly and weekly upper income limits for  MassHealth, the Medicare Savings Programs, the Health Safety Net, and CMSP reflecting the 2025 increase in the Federal Poverty Level (FPL). The updated figures are not applied by MassHealth until March 1. The…

Health Care Access Programs -- BBT Training

HLA, BPHC, HCFA, GBLS, MLRI
Materials from the February 4, 2025 Health Care Access Programs training, presented as part of the MLRI/MCLE Basic Benefits Training Series: Handout Materials Agenda (pdf) About the Faculty  How to Apply for Public Health Insurance Benefits in Massachusetts (pdf of…

Benefits Included in MassHealth by Coverage Type 2025

MLRI
Attached is a Table prepared by MLRI of the different kinds of services and service providers that are available under the various MassHealth coverage types described in MassHealth eligibility regulations & cross referencing to MassHealth fee for service regulations. It's been updated for…

Federal Poverty Guidelines - 2025

MLRI
The charts below set forth the annual, monthly and weekly 2025 Federal Poverty Guidelines (based on HHS thresholds).  In addition, the annual, monthly and weekly 115% of poverty, 125% of poverty,  187.5%, 200% of poverty and 300% of poverty amounts are listed. Finally, you can…

Medicare Savings Program for CommonHealth members

CMS & MassHealth
April 2025 Update: In April 2025 MassHealth redetermined MSP eligibility for  14,000 CommonHealth members enrolled in Medicare. Approximately, 14,000 with income of 225% FPL or less were able to newly qualify for Medicare Savings Program (MSP) benefits or were upgraded from SLMB/QI to QMB.…

MassHealth & Health Connector Unwinding Policy Updates (April 2024)

MassHealth & Health Connector
Attached is the  MassHealth & Health Connector Learning Series Update for the Spring 2024 Massachusetts Health Training Forum (MTF). In the MassHealth section it includes information about the status of various policies in place during the unwinding. Some are ending in 2024 in April, June…

MassHealth Language Access Plan 2024-2025

Office of Medicaid
On March 28, 2024 MassHealth updated its language plan for 2024-2025.  Attached below is the prior LAP for 21-23 and the 24-25 plan. The link below is to the 24-25 plan. Also see Governor Healy's Executive Order 615 (Sept 13, 2023) Promoting Access to Government Services and Information by…

2024 Upper Income Limits for MassHealth and other Coverage Programs

MLRI
Attached is MLRI's March 1, 2024 Table upper income limits in MassHealth, MSP, Health Safety Net, CMSP and ConnectorCare, along with the Nov 1 2024 Table (updated Jan 30, 2025) showing the updated income limits for ConnectorCare coverage in 2025; open enrollment for 2025 begins on Nov 1,…

Lawsuits challenging Medicaid Redeterminations in FL and NC

NHelp with Florida Health Justice and with Charlotte Legal Advocacy
With the nationwide end of the pandemic-related continuous coverage/maintenance of effort policy that was in effect from March 17, 2020 until Mar 31, 2023, there has been a nationwide spotlight on administrative barriers that result in eligible Medicaid members losing coverage at…

MassHealth Overpayments

State Auditor and MLRI
Attached are excerpts from the State Auditor's FY 2023 BSI Annual Report in which it explains that CMS prohibits collection of overpayments from beneficiaries (except in limited circumstances) and that pursuant to this directive, the BSI has suspended civil collection of beneficiary overpayments and…

2023 Upper Income Limits in MassHealth and Health Connector

MLRI & MassHealth
MassHealth updates its income standards with the current year's poverty level on March 1. Attached is MLRI's table showing the upper income levels for MassHealth and Health Connector programs, updated to show the cost of living adjustments for 2023 that take effect in MassHealth…

How Money Damages and Settlements Impact Selected Public Benefits

MLRI
The following chart provides an overview of the income and asset limits for common public benefits, healthcare, and housing assistance programs, and highlight rules regarding the treatment of lump sums from money damages payments and settlements. The chart is primarily intended for use by legal…

Comments on Proposed MassHealth 1115 Amendments

MLRI, CHLPI, HCFA
In August 2023 MassHealth proposed 8 amendments to the current 1115 demonstration, with an opportunity to comment by Sept 9, 2023 including proposals to:  Provide 12-months continuous eligibility for all adults (continuous eligibility for children is already required as of Jan 1,…

What's in the Blue Envelope for People Turning 65

MassHealth
MassHealth is in the process of renewing eligibility for all its 2.4 million members during the one year period from April 1, 2023 to March 31, 2024. If eligibility can't be renewed through data matching, beneficiaries will be sent a blue envelope with a notice dated April 1, 2023 or later to be…

MassHealth Renewal: What's in the blue envelope for people under 65?

MasHealth
MassHealth is in the process of renewing eligibility for all its 2.4 million members during the one year period from April 1, 2023 to March 31, 2024. If eligibility can't be renewed through data matching, beneficiaries will be sent a blue envelope with a notice dated April 1, 2023 or later to be…

MassHealth Reinstated People Wrongly Terminated based on "Change in Household" Prior to March 31, 2023

MassHealth & MLRI
Over the last six months, advocates have brought cases to light of people losing MassHealth despite the continuous coverage protection  based on reported changes that were treated by the computer system as voluntary withdrawals when that was not what the member intended. A voluntary withdrawal…

MassHealth Managed Care Options in 2023

Various
On April 1, 2023 MassHealth members subject to mandatory managed care will have a new set of managed care options. These changes do not apply to people 65 or over or Medicare beneficiaries with voluntary managed options in SCO or One Care, or to other MassHealth members with MassHealth secondary to…

CMS directs Medicaid agencies to reinstate duals who were downgraded to Medicare Savings Programs only

CMS
On Mar 7, 2023 CMS issued a notice to all state Medicaid agencies pursuant to an injunction entered against CMS in a nationwide class action called Carr v Becerra filed in federal district court in Connecticut. The class consisted of people who had been determined eligible for Medicaid after…

A bill to reinstate 3 months retroactive MassHalth Coverage in 2023

MHA & MLRI
Attached is a fact sheet on a bill filed in the 2023 session to restore retroactive MassHealth coverage; MassHealth plans to end this coverage for new applicants 19-64 who are not pregnant when the COVID-19 Public Health Emergency ends expected to be this spring.

Record of COVID-19 Related changes affecting Health Coverage from March 2020-23

MLRI
UPDATE MAY 11, 2023 END OF FEDERAL COVID-19 PUBLIC HEALTH EMERGENCY On May 11, 2023 the Secretary of HHS ended the federal COVID-19 Public Health Emergency. See related materials here The COVID-19 Health Changes Table was last updated in March 2023 and should only be used as a reference for…

Nursing home residents file class action to enforce rights to less restrictive settings

Center for Public Representation & GBLS
This is the complaint and link to the CPR website with more recent developments in  a class action lawsuit alleging Massachusetts’ officials have unnecessarily institutionalized individuals with various disabilities in nursing facilities and have failed to provide community residential services…

Student Health Insurance Flyer

Massachusetts Law Reform Institute
In Massachusetts, college students must have health insurance. Students will be enrolled in their school-based insurance, unless they have other coverage and waive the school-based insurance by their school's deadline.    MLRI made the attached flyer (see English and Spanish…

Record Requests

MLRI & others
Attached are sample documents making a public record request to the MassHealth agency, and appealing from the agency's failure to supply the requested records.  The Secretary of State oversees compliance with the state public record law & puts out a guide to the law. This…

MassHealth Behavioral Health for Criminal Justice Involved People

MassHealth
This MassHealth website describes a program to connect "justice-involved" people with  behavioral health services & social supports in the community. "Justice-involved" includes:  • people leaving jail or prison within six months, • people who…

Tips for Communicating with Optum

MLRI
This May 2022 updated memo by MLRI provides contact information for MassHealth's Third Party Administrator for certain Long Term Services and Supports (LTSS), Optum. Optum began making prior authorization decisions for PCA and certain other LTSS services in the summer of 2017. The updated…

MassHealth Managed Care Contracts

MassHealth
At this website MassHealth has posted its contracts with its managed care plans including the MCOs, the ACOs, the Behavioral Health Partnership, and the One Care and SCO plans. When researching the scope of covered services for a beneficiary enrolled in a managed care plan, the contract may have…

CCA One Care Coverage Exceptions for non-covered benefits

Various
In Feb 2022 CCA updated and published its Medical Necessity Guidelines for otherwise NonCovered Services (PDF is attached) & posted it here: https://www.commonwealthcarealliance.org/ma/wp-content/uploads/2023/01/Non-Covered-Benefit-MNG-100_20230124.pdf Thanks to Central West Justice…

Mass. Health Care Training Forum Notice April 6 2022

MassHealth and Health Connector
This announcement distributed to the Mass. Health Care Training Form email list on April 6, 2022, describes several upgrades to the HIX Eligibility System including- A new option to allow people who will be eligible for ConnectorCare  with income of 150% FPL or less to check a box to be…

Unequal Housing Conditions And Code Enforcement Contribute To Asthma Disparities In Boston, Massachusetts

Evan Lemire, Elizabeth A. Samuels, Wenyi Wang, and Adam Haber
Housing quality is a primary determinant of asthma disparities by race and social class in the US. We sought to assess how housing code enforcement systems in Boston, Massachusetts, address tenants’ reports of asthma triggers. After adjustment for income and other neighborhood characteristics,…

March and Nov 2022 Upper Income Limits in MassHealth and Health Connector

MLRI
MassHealth updates its income standards with the current year's poverty level on March 1. Attached are tables from MLRI showing the upper income levels for MassHealth and Health Connector programs, updated to show the cost of living adjustments for 2022 that took effect in MassHealth…

Updated Office of Medicaid Guidance on Cuban-Haitian Entrants

Office of Medicaid
This Feb 2022 Eligibility Operations Memo from the Office of Medicaid provides information on how to identify Cuban-Haitian entrants who are "qualifed aliens" eligible for medical benefits on the same terms as US citizens. It updates an earlier June 2020 El Ops Memo to include examples of…

Update on Haitian Entrants

Misc
Feb 2022 UPDATED MassHealth Guidance on Cuban-Haitian Entrants https://www.mass.gov/doc/eom-22-03-eligibility-rules-for-cuban-and-haitian-entrants-0/download  Background Information on Newly Arriving Haitians Recently, hundreds of Haitian families, many with children, have arrived in…

MassHealth Protection Notices During COVID-19

Office of Medicaid
This is a copy of the "protection notice" that MassHealth is sending out to certain beneficiaries who had been sent a renewal form, request for information or reported a change. It notifies them that they are still enrolled in their current coverage, not because they are eligible for it,…

ABCs of Seeking Judicial Review of a MassHealth Board of Hearings Decision

MLRI
Attached is an updated guide on the process of filing a complaint for judicial review of a MassHealth fair hearing decision. Please contact Kate Symmonds (ksymmonds@mlri.org) if you notice any errors or have any tips for other advocates; and please be sure to check the court rules and statutes for…

March & Nov 2021 Update of FPL Tables in MassHealth & Health Connector

MassHealth & MLRI
Attached are updated Tables from MassHealth and MLRI showing the upper income levels for MassHealth and Health Connector programs. It is updated to show the cost of living adjustments for 2021 that take effect in MassHealth programs on March 1, 2021. The Health Connector uses the 2020 federal…

Health Benefits for Newly Arriving Afghans

MLRI
Massachusetts will soon be home to several thousand newly arriving Afghans. Most should be eligible for health coverage in MassHealth Standard or CarePlus. We have created this google doc to keep you abreast of the latest information we have to help new arrivals receive the correct…

IRS Stimulus Payments Never Treated as Assets

Office of Medicaid
This announcement from MassHealth clarifies that IRS Stimulus payments (also called Economic Incentive Payments or Recovery Rebates) are not income in the month of receipt and unspent funds will not be treated as countable assets for 12 months from receipt and for the duration of the federal public…

EOHHS v. Trocki Medicaid Estate Recovery Decision

Appeals Court
In this Aug 5, 2021 Appeals Court decision, the Court reversed the Superior Court's summary judgment in favor of EOHHS in a Medicaid estate recovery claim under G.L. c. 118E, Sec. 31 in which the claim consisted entirely of capitated monthly payments to a Senior Care Options (SCO) program.…

MassHealth Estate Recovery webinar for assisters & legal aid July 22, 2021

MLRI
MassHealth Estate Recovery A webinar for enrollment assisters & legal aid advocates July 22, 2021, 2-3 pm Recording & slides of July 22 Estate Recovery webinar now available. If you missed the July 22, 2021 Estate Recovery Webinar, the recording is posted here on the…

MassHealth Monthly Copay Caps

MassHealth
MassHealth mailed notices to members about a monthly cap on copayments beginning July 1, 2021 that will reduce the amount of copayments people with multiple prescriptions per month will have to pay.  However, the wording of the notice has led to widespread confusion with many people thinking…

MassHealth's May 2021 Changes to its COVID Continuous Coverage Protections

MLRI
Attached is a memo written by MLRI explaining MassHealth's guidance issued on May 4, 2021 describing certain changes in the continuous coverage protections in place during the federal public health emergency including advocacy that may be needed to protect some people from losing access to…

New Brokerage System for MassHealth PT-1 Nonemergency Transportation July 1, 2021

Office of Medicaid
MassHealth members in Standard, CommonHealth and CarePlus are eligible for non-emergency transportation assistance to get to and from their appointments with MassHealth providers if  they cannot use public transportation due to a disability or medical condition or because there…