New Free Care Regulations Restrict Outpatient Hospital Care
The Massachusetts Division of Health Care Finance and Policy has released proposed regulation changes to the Uncompensated Care Pool, ("Free Care"). A public hearing on the regulations is scheduled for Tuesday, August 24, 2004 at 10:00 A.M. at Two Boylston Street, Boston, MA. Staff may want to attend or consider informing interested patients and families. The final regulations are scheduled to go into effect on October 1, 2004.
Hospital Outpatient Clinics Only Covered for "Critical Access Services"
Under the proposed regulations, the pool would steer routine primary care to community health centers. The pool would only cover hospital outpatient primary care visits if:
Residency
Under the proposed regulations the residency definition is changed to clarify that college students and persons confined in a nursing home, hospital or other medical institution, and individuals that come to Massachusetts for the purpose of receiving medical care and who maintain a residence outside of Massachusetts are NOT considered residents of Massachusetts.
Definition of "Family" and Inclusion of Income
The proposed regulations change the definition of family to be consistent with MassHealth eligibility criteria, so that the income of all household members will be considered.
MassHealth Application Required, Medicaid to Process Free Care Application for Under 65
Except in emergencies, the regulations would require applicants under age 65 to complete a MassHealth application before being approved for Free Care. The Office of Medicaid, rather than providers (e.g., the hospital), will determine whether the individual qualifies for MassHealth, Free Care or neither, and notify the patient. There will be a transition period during which providers will be permitted to continue submitting applications. Providers will continue to process Free Care applications for those over 65 and cases of "medical hardship" (see below).
Medical Hardship
There is no income limit to qualify for Medical Hardship. To qualify, the patient must be a Massachusetts resident, AND his/her total "Allowable Medical Expenses" must be greater than 30% of the Family Income AND the amount by which these expenses exceed 30% of the family income must be greater than the family's "Available Assets". Available assets do not include the primary residence, the first motor vehicle, and a resource exclusion of the first $4,000 of other assets for an individual, or$6,000 for a Family of two, and $1,500 for each additional Family member. The applicant's required contribution is the sum of 30% of Family Income and Available Assets. In other words, the family must have bills totaling more than 30% of income that the family can't cover even using all their liquid assets except for the resource exclusion. There is one Medical Hardship contribution per Family per eligibility period. The applicant will remain responsible for all Allowable Medical Expenses up to this Medical Hardship contribution.
For information on current Free Care policies and related MGH and MGPO policies, Social Service staff can go to our website www.mghsocialwork.org and follow the path "Staff Access > Community Resource Center > Basic Needs > Health Care Coverage > Free Care".
-Adapted from HCFA MassHealth defense e-mail 7/19/04. "Pool Regulations May Restrict Outpatient Hospital Care", Notice of Public Hearing at: www.mass.go/dhcfp/pages/dhcfp_40.htm#pool and related regulations. Thanks to Steve Kelly for his assistance.
07/2004