The Health Safety Net Trust Fund (formerly "Free Care")- Final Regulations

In the July edition, the MGH Community News reported on preliminary rules for the Health Safety Net Trust Fund(formerly known as the Uncompensated Care Pool or Free Care). On Friday September 21, 2007, the Massachusetts Division of Health Care Finance and Policy issued final regulations governing the new Health Safety Net Trust Fund, that take effect October 1. Replacement of the Pool with the Fund was included in the Health Reform Law, Chapter 58, back in April 2006.

Important changes include a change from block grant to a claims based program. The key population relying on the Safety Net will be undocumented immigrants – as they are not eligible for Commonwealth Care.

Below are the highlights from the final Health Safety Net Regulations on eligibility and cost-sharing.

Eligibility

• Current income guidelines for Safety Net eligibility remain the same. Individuals and families between 0- 200% federal poverty level (FPL) will still be able to qualify for the Safety Net. Individuals and families between 200%-400% FPL will continue to qualify for partial care, subject to a deductible based on income.
• During the Commonwealth Care roll-out patients could elect to remain on Free Care. Now if they are MassHealth or Commonwealth Care eligible, and do not enroll in those programs, they will no longer be eligible for the Safety Net.
• Starting in April 2008, one may use the Safety Net only if their offer of employer sponsored insurance is considered “unaffordable”. If one’s employer offers an affordable plan, they can be eligible for the Safety Net only up until the time of the next open enrollment. To determine if the employer sponsored plan is considered affordable, click here and download the appropriate fact sheet for that county.
• If one is deemed eligible for Commonwealth Care or MassHealth Essential and Basic, Safety Net eligibility begins 10 days prior to the date of application and 90 days after the date of application. If determined eligible for Commonwealth Care, applicant will also be covered by the Safety Net for the period between enrollment and the start date of coverage.

Deductibles
For individuals and families under 200% federal poverty level (FPL), the will be no deductibles. The proposed regulations recommended a cumulated monthly deductible at $35/month, a provision opposed by advocates and subsequently removed. For those between 200%-400%, deductible rates remain at current levels.

Co-pays
Adult individuals and families between 100-200% FPL will now have to pay co-pays for services at hospitals, but not at Community Health Centers (including hospital-affiliated health centers). Children age 18 and under will not need to pay any form of cost-sharing (co-pays and deductibles). However, all members of the Safety Net, regardless of income eligibility or site of service, must pay the co-pay for prescription drugs.
Safety Net members from 0-100% FPL, and members in partial care, 200-400% FPL, will not be subject to co- pays (remember those over 200% have significant deductibles).

Co-pay Structure

• $5 for outpatient care at a hospital
• $50 for inpatient admission
• $50 emergency care (waived if admitted)
• Prescription Drugs: $1 for generic, $3 for single source (brand name)- at all sites, starting on December 1, 2007.
• The annual maximum for co-pays is $250.
  

Covered Services
The Safety Net will now cover the same services that MassHealth Standard covers. Click here for a list of MassHealth-covered services.

Health Safety Net - Secondary
For those with other primary health insurance and Family Income up to 200% FPL, the Safety Net acts as secondary insurance.

• Students enrolled in a Qualifying Student Health Plan are eligible
• Those with Commonwealth Care are only covered for dental services not covered by Commonwealth Care
• Not eligible: those with MassHealth Standard, CommonHealth, Essential, Basic, or Family Assistance
  

Health Safety Net - Partial

• This represents no change from current Uncompensated Care Pool rules
• Eligibility requires family income of 201% - 400% of the FPL and meeting a deductible equal to 40% of income in excess of 200% FPL
• There is only one deductible per Family per approval period (year)
  

More information:
This information and more detail will be available shortly on the Staff Access area of our website. In the meantime:

• Final regulations at the official Health Safety Net website.
• What Health Care for All has to say.
• EOHHS press release (PDF) about this change.
• Alice Dembner's September 22 article in the Boston Globe.

-Adapted from: “New Rules - SafetyNet/Uncompensated Care Pool” e-mail, Health Care For All, September 25, 2007 and “Rules for Health Safety Net established”, Community Partners, September 24, 2007, e-mail forwarded by Kim Simonian (Thanks Kim!), and at . http://www.compartners.org/node/819 and the “Health Safety Net Eligible Services Final Regulation (114.6 CMR 13.00)”, available here.

09/07