Immigrants

On January 16th, 2004, the Legislature directed the Romney administration (through a veto override of a provision in the supplemental budget) to restore MassHealth coverage (in the form of MassHealth Essential) to up to 2,750 elderly and disabled legal immigrants who lost coverage on August 1st if there are sufficient funds in the MassHealth Essential account. It is unclear how this will be implemented, although it is conceivable that DMA will automatically upgrade these individuals since they are already in the MassHealth system on MassHealth Limited. EOHHS report was released on March 25; Their initial assessment projects that there will be enough money to cover the 2750 legal senior and disabled immigrants who lost their coverage this past August. Coverage is expected to begin June 1st.

Premiums

• On April 1st, MassHealth adopts the new Federal Poverty Levels that were published in February, (http://www.ocpp.org/poverty/index.htm and on Staff Access area of our website) and has agreed to review all households and individuals currently required to pay premiums and notify them if the new levels make a difference in their case (i.e., in case their income now falls into a lower income category that does not require premium payments). Members should be urged to check their income against the new levels themselves, in case MassHealth neglects to review their case correctly.
• Approximately 2,000 households were terminated in February for failure to pay premiums. It appears that premiums are disproportionately affecting households with children. Disabled members seem to be paying premiums more regularly, since they may have ongoing health care needs, whereas families with children who are healthy may drop their coverage and forgo preventive visits.
• DMA has issued proposed regulations outlining hardship criteria. The comment period is over, and the final rules will go into effect on April 15th. According to the proposed (i.e., may change) regulations, extreme financial hardship means that the member has shown to the satisfaction of MassHealth that the member
  • is homeless, or is more than 30 days in arrears in rent or mortgage payments, or has received a current eviction or foreclosure notice
  • has a current shut-off notice, or has been shut off, or has a current refusal to deliver essential utilities (gas, electric, oil, water, or telephone)
  • has medical and/or dental expenses that total more than 7.5% of the family group's gross annual income that have not been paid by a third party insurance, including MassHealth
  • has experienced a significant, unexpected increase in expenses within the last six months.

Asset Testing

DMA has decided to not implement asset tests for the remainder of the fiscal year (through June 30, 2004). It appears that planning is continuing for implementation next year. There is the possibility that CommonHealth members may be exempt from asset testing; however, their premium amount would be raised instead.

MSCPA

(Not to be confused with the MSPCA. Fill-in your own "the state treats animals better than people" joke here).

Effective March 1st, 2004, MassHealth requires all individuals who are eligible for MassHealth Standard or CommonHealth to obtain and/or maintain available group health insurance, under the MSCPA (MassHealth Standard/CommonHealth Premium Assistance) program.

• Currently, MassHealth applicants get asked whether they have access to health insurance through their employer. Now, MassHealth will have a contractor investigate every situation where an applicant may have insurance available to him/her, and will assess the cost effectiveness of paying for the employee's share of the insurance rather than insuring the applicant through MassHealth.
• Until March 1st, participation in this program had been voluntary and the program had been called the Health Insurance Premium Program (HIPP). Now, it is only voluntary for members under age 19.
• The applicant would receive full MassHealth coverage for a 60-day transitional phase while this assessment was completed. Then, there would be another 60-day period to setup the arrangement. Finally, the applicant would receive 2 insurance cards - 1) their private insurance card through their employer; and 2) a MassHealth card to cover areas where there are gaps in coverage, and to be used to pharmacy co-pays and other co-pays.

There are several potential problems in the implementation of this change.

• An employee may be locked into an unsatisfactory provider network through his/her employee, and it's unclear whether the individual would be able to use his/her MassHealth card to go out of network.
• Pharmacies may mistakenly charge the co-pay level for the private coverage as opposed to the MassHealth co-pays. (This has been a problem in the voluntary program.)
• The State must keep up with each individual member and changes to his/her employer plan.

Healthy Start

Since the Healthy Start application was eliminated and women have had to apply with the MBR, enrollment in Healthy Start has jumped, presumably because more women are being captured who weren't sure they were eligible for Healthy Start. As of the end of March, enrollment is at around 5,000 women.

-Kim Simonian, Health Access and Community Partnerships Partners Community Benefits with additional information from Karla Fortunato, Health Care For All, MassHealth Defense project.