MassHealth HIV Re-expands to 200% FPL

Early this month MassHealth issued Eligibility Letter 130, officially announcing an increase in the income cut-off for HIV coverage from 133 to 200% FPL. The emergency regulations carry an effective date of July 1, 2004.

You may recall that this program had been at 200% FPL and then was a victim of budget cuts. The state subsequently decided to restore it to the 200% level. Unfortunately the timely implementation of the reinstatement was blocked by the requirement to get a federal Medicaid waiver, even though it was a reversion to old policy. These negotiations dragged on. Kim Simonian reports from the MassHealth defense group that “Negotiations over the details of the federal MassHealth waiver are due to be completed by 3/27; however, the state is hoping to gain an extension of that deadline. The funds are no longer in immediate jeopardy.”

It is unclear at this time if those who were cut-off due to this income eligibility change will receive retroactive coverage, as might be assumed by the retroactive effective date. In the past we were informed there would be no retroactive coverage. The state should be sending letters to those who lost coverage in the intervening time to inform them they will need to re-apply. Advocates should be alert to any qualifying clients who may have moved in the interim.

03/2005