MassHealth Premium Wavier Clarified

It was reported in this space in June of 2004 that those subject to paying a premium under MassHealth could request to have this premium waived if they could document “extreme financial hardship” ( http://healthcare.partners.org/ss/ssframebottom/staffresources/news/2004/06-04MHPremiumHardshipWavier.html). These regulations were recently updated. Effective June 15, 2005 the “medical expenses” justification now has to meet the following criteria. The member:
”has medical and/or dental expenses, totaling more than 7.5% of the family group’s gross annual income, that are not subject to payment by the Uncompensated Care Pool, and have not been paid by a third-party insurance, including MassHealth (in this case “medical and dental expenses” means any outstanding medical or dental services debt that is currently owed by the family group, regardless of the date of service)”.

The revisions also clarify that hardship waivers are authorized for six months beginning in the month after the request is granted. Members may submit another request at the end of the six-month period.

If a member chooses to withdraw from MassHealth, coverage continues through the end of the calendar month of the withdrawal. The member is responsible for paying all premiums due, up to and including that calendar month of withdrawal.

- Adapted from MassHealth Eligibility letter 133, June 15, 2005.

06/2005