MassHealth Updates
Immigrant Coverage
The Office of Medicaid has agreed to an interim continuation of coverage for certain senior and disabled legal immigrants. Although funds specifically appropriated for these 3,300 people have been used up, the Administration will use other surplus MassHealth funds to continue their coverage for the rest of the fiscal year.
As reported earlier, emergency regulations went into effect January 1 requiring this population to demonstrate that they never had a sponsor or their sponsor is deceased or has income under 200% FPL in order to remain on Essential. On March 1, MassHealth will send out a second notice to this group, asking for information on their immigration status, and on the income of their sponsor. Replies will be due by April 1.
After receiving the replies, MassHealth will eliminate coverage for those with sponsors' income over 200% of the poverty level, or those who do not reply. It appears as if members who do not respond to the mailing, or those whose sponsors are above income, may be automatically downgraded to MassHealth Limited. The remainder will be covered for the rest of the fiscal year.
MIRA advises that we let clients know that the Office of Medicaid is NOT interested in
pursuing sponsors with income over 200% of FPL. That is not their job nor do they have the resources to do it.
Note from the CRC: we don’t have any official corroboration of this, but it would seem that those whose sponsor has income of over 200% should submit their reply as close as possible to the deadline to avoid early termination/downgrading. It is probably best to submit the form, however, rather than not reply at all.
Homeland Security Database
MassHealth Member Education reported at a recent meeting that the state has started to match applicant information against a Department of Homeland Security database, in addition to the Department of Revenue match they are already doing to check income. Obviously, this alarmed many attendees, who asked the state for reassurance that those applying for MassHealth Limited, Healthy Start, CMSP, and Free Care would not be subjected to that match. Kim Simonian, of Partners’ Community Benefits, reports “We will keep trying to get clarification on this process and what it means for what we tell patients who are applying with the Virtual Gateway.”
Essential Cap
MassHealth Essential now has 2 different caps: its funding is capped by the Legislature, and is projected to cover between 41,000 – 42,000 members; and its enrollment is capped by the federal government at 44,000 members. The state projects that enrollment will reach the state cap in a month or two, and the program will need to be closed again. A waiting list would be re-established.
-Adapted from Health Care For All e-mail “MassHealth Defense: Meeting Tuesday Feb 22”, Kim Simonian’s notes from same meeting and from a MassHealth Technical forum held in late January, and e-mail from Carly Burton, MIRA, 2/18/05.
Monthly Transfer Penalty Divisor Lowered
The Office of Medicaid has redetermined the transfer penalty down from $244 a day to $232 a day effective for MassHealth applications filed on or after February 1, 2005. In other words, the penalty for asset transfers has increased from one day of ineligibility for every $242 transferred to one day for every $232 transferred. On a monthly basis, the penalty has increased from one month of ineligibility for every $7,320 transferred to one month for every $6,960 transferred.
Under state and federal law, this number must be based on the Commonwealth's determination of the average cost of nursing home care. Under the settlement of a lawsuit challenging the Commonwealth's refusal to adjust its figure with inflation, it must now make such an adjustment each November 1. This adjustment is three months late and contrary to the experience of anyone but the Office of Medicaid.
Everyone whose nursing home fees have declined over the past year, please raise your hand.
2005 MassHealth and Medicare Numbers:
MassHealth
Maximum Community Spouse Resource Allowance (CSRA): $95,100
Minimum CSRA: $19,020
Maximum Minimum Monthly Maintentenance Allowance (MMMNA): $2,377.50
Minimum MMMNA: $1,561.25
Monthly Transfer Penalty Divisor: $6,960
Medicare
Part A deductible $912
Part B premium $78.20
Part B deductible $110
Hospital co-pay for days 61- 90$228/day
Hospital co-pay for days 91 and beyond $456/day
SNF co-pay for days 21- 100 $114/day
- From Margolis & Associates’ ElderLaw News 2/7/0502/2005