MASSHEALTH BENEFITS TO BE RESTORED JULY 1, 2006

As reported previously, due to a new state law, starting July 1, 2006, MassHealth will cover more services for members aged 21 years or older (adults). (MassHealth already covers these services for members under the age of 21.)

Adults who are enrolled in MassHealth Standard, Prenatal, CommonHealth, Basic, and Family Assistance for persons with HIV can get all of the additional services listed below. Adults who are enrolled in MassHealth Essential can get all of the additional services listed below, except for vision, chiropractor, and orthotic services. MassHealth Essential does not cover those services.

MassHealth will cover the following services for eligible adults, starting July 1, 2006. Certain conditions and limitations may apply (for example, some services need prior approval).

• Dental Services. MassHealth will cover medically necessary dental services including checkups, cleanings, fillings, certain endodontics (like root canals), and dentures. Some of these services need prior approval. Adults will no longer have to qualify for special circumstances to get these services. There will be no interruption in the services you are currently receiving. For a list of dentists who accept MassHealth, go to www.mass.gov/masshealth/dentists. The state recognizes the access difficulties that may abound, given the limited number of dentists accepting new MassHealth patients and the possibility that many members will want to access these services immediately. MassHealth is also outreaching to dentists through their new part-time dental director, and will send a letter to all dentists in MA, encouraging them to participate in the program.
• Vision Services. MassHealth will cover medically necessary eyeglasses, eyeglass parts, eyeglass dispensing, certain contact lenses, and other visual aids, including magnifying aids. (These vision services are not covered for members enrolled in MassHealth Essential.) Vision exams continue to be covered by MassHealth.
• Chiropractor Services. MassHealth will cover medically necessary services you receive from a chiropractor. (Chiropractor services are not covered for members enrolled in MassHealth Essential.)
• Orthotics. MassHealth will cover medically necessary orthotic services. In addition to other changes, coverage for orthotic shoes will no longer be restricted to members with severe diabetic foot disease. (Orthotic services are not covered for members enrolled in MassHealth Essential.)
• Prosthetics. MassHealth will cover medically necessary prosthetic services.
• Certain 24-hour substance abuse treatment services. MassHealth will cover 24-hour post-medical detoxification substance abuse treatment services, defined as Level IIIB and Level IIIC by the Massachusetts Department of Public Health’s Bureau of Substance Abuse Services.
• Acute hospital inpatient administratively necessary days. MassHealth will cover all administratively necessary inpatient stays.
• Tobacco Cessation Services for Members of Any Age
  In addition to the services listed above, as of July 1, 2006, MassHealth will cover tobacco cessation services for eligible MassHealth members of any age who smoke or use tobacco products, such as chewing tobacco. MassHealth will cover tobacco cessation services for members enrolled in MassHealth Standard, Prenatal, CommonHealth, Family Assistance for persons with HIV, and for members who get direct coverage (not premium assistance) for MassHealth Basic, Essential, and Family Assistance for children.

MassHealth members may receive group or individual counseling by requesting tobacco cessation counseling services from their doctor. These services are available through MassHealth physicians, community health centers, and hospital outpatient departments (other than the emergency department). Also, members may request a prescription from their doctor for nicotine replacement medicine, including nicotine patches, gum, and lozenges, and certain other medicines to help members in the process of quitting tobacco.

And don’t forget these other changes:

• See accompanying article on expansion of MassHealth for most children formerly on CMSP.

• Raised enrollment cap on MassHealth Essential from 43,000 to 60,000 members. Unfortunately, final approval for this particular change is tied up with the overall federal approval process for the state's Medicaid waiver, which is not expected until mid July. Therefore, on July 1st, the state will only enroll 1,000 individuals from the wait list onto Essential (due to some existing wiggle room with the cap); the remaining 10,000 or so will be enrolled from the wait list in mid July, or whenever the state receives final approval on its Medicaid waiver from CMS.

• Wellness benefit: The health care reform legislation requires MassHealth to develop a wellness benefit for its members by July 1st, whereby members can receive breaks on cost sharing if they participate in wellness initiatives. This will not be ready by July 1st, and may take as long as another year for the state to design. This is a brand new type of benefit for MassHealth to offer, and the state needs to decide how it will design the benefit and structure the incentives in order to maximize participation and produce results.

-Adapted from Important Message about Your Health Benefits, letter from EOHHS and several extremely useful and timely e-mails throughout June 2006 from Kim Simonian, Partners Community Benefit Programs, Health Access and Community Partnerships.

06/06