CMSP MEMBERS GET COVERAGE UPGRADE, NEW PREMIUMS

In July 2006 Children’s Medical Security Plan (CMSP) members whose families fall between 200-300% of the federal poverty level will be one of the first groups whose access to health care will be re-shaped by health care reform legislation. All eligible CMSP members (about 9200 individuals) will be upgraded to MassHealth Family Assistance Plan coverage; only undocumented children will remain on CMSP once the transition is complete. MassHealth sent a letter, (known as “the blue letter”, see a copy at www.compartners.org/pdf/news/6-8-06_cmsp_letter.pdf ) to CMSP families at the end of May explaining the new coverage and new, higher, premiums. Though the premiums for these children will be slightly higher, there won't be any other cost sharing, such as co-pays or deductibles. Families should continue to pay their CMSP premiums until they receive a bill for MassHealth coverage, due later in the summer. If families do not pay their CMSP premiums, they will be dropped from coverage; they will not be automatically enrolled in MassHealth. They would experience a break in coverage and possible delays in re-enrollment. In the beginning of July, these families will receive approval notices with their new premium amounts. Their first MassHealth premium bills will be sent out in August, due in September.

The benefits to these children of inclusion in MassHealth are significant. CMSP is a limited benefit program that primarily covers routine outpatient and preventative services. Once on MassHealth these children would have full coverage. Specific benefit upgrades include coverage of inpatient services, outpatient surgery and anesthesia, coverage for inpatient mental health and substance abuse services, eyeglasses and hearing aides, and medically necessary dental services, medical equipment and prescription drugs without the dollar-level caps imposed under CMSP. For a detailed side-by-side comparison please see the chart on Community Partners’ website: www.compartners.org/pdf/news/6-9-06_coverage_chart.pdf.

New Applicants: Those already enrolled in CMSP will be autenrolled in MassHealth as outlined above. Any children who are newly applying for coverage after July 1st who are between 200% and 300% FPL and meet other existing MassHealth eligibility requirements will now be found eligible for MassHealth, as opposed to CMSP. However, there are some "crowd out" provisions that will be applied to these new applicants. They must not have had insurance within the last 6 months OR one of the following applies: they involuntarily lost their insurance; the child has special health care needs; a parent died; insurance was lost due to a domestic violence situation; insurance was lost due to becoming self employed; or existing coverage's lifetime benefits were reduced substantially. These provisions apply to those who apply on or after July 1, 2006.

-Adapted from CMSP members get coverage upgrade, new premiums, June 8, 2006 at http://www.compartners.org/node/448, and MassHealth changes coming July 1 as part of Health Care Reform e-mail, from Kim Simonian, Health Access and Community Partnerships, Community Benefit Programs, Partners HealthCare June 6, 2006.

Premium Changes From CMSP To MassHealth Coverage

In July 2006, the transition from CMSP to MassHealth coverage will begin for most children
whose families are between 200% - 300% of the federal poverty level (FPL).

Children who are undocumented will remain on CMSP;
their status deems them ineligible for MassHealth coverage.

06/06