UPDATES: MASSHEALTH, COMMONWEALTH CARE & CHOICE, AND HSN

MassHealth members have less time to return ERVs

Starting December 1, 2007 MassHealth members only have 45 days to return their annual eligibility review forms (ERVs- members previously had 60 days). MassHealth estimates that this change will result in 300 additional members being terminated each month (already, about 3,000 fall off each month due to this requirement). Sometime in early 2008, the state will be launching a new feature in the Virtual Gateway, whereby financial counselors will be able to complete on-line streamlined renewals for members whose redeterminations are due. This will help counselors to identify and outreach to patients who need to complete their forms, and will hopefully reduce the effects of this change.

Some retroactive Health Safety Net coverage is not showing in REVS
Retroactive Health Safety Net (HSN) is not showing in REVS for patients in several categories, including MassHealth Essential and Basic patients, who should have 10 days of HSN retroactive. This is a glitch in the state system; they are aware of the problem and are working to fix it. Providers should watch for cases like this where patients need the 10 day retro to cover past dates of service.

Undocumented immigrants can join Commonwealth Choice
Just a reminder: Low income undocumented immigrants continue to be eligible for the Health Safety Net. However, if they file taxes, they are subject to the individual mandate to have health insurance and Health Safety Net is not considered insurance for the purposes of the mandate. Some of them may be waived from the penalty, due to a lack of affordable coverage available to them. Anyone who can afford it can always purchase a Commonwealth Choice plan directly from an insurer. A social security number should not be a requirement for enrollment. Please let Kim Simonian (Partners Community Benefits) know if you have any patients who have been turned away by a health plan for that reason.

HSN Confidential applications
Protection for minors seeking confidential services (family planning and STD services) continues under the new Health Safety Net regulation. The regulation specifies that providers should be using the Division's old electronic Free Care application for these patients - the same process that was in place under Free Care. The state is creating a new application form specifically for this population. Battered and abused individuals who want to apply for coverage confidentially may apply for coverage with the Virtual Gateway, and may use their own income information and an alternate address.

Women on state programs who become pregnant
There was a recent example at a Partners institution of a legal immigrant on Commonwealth Care who became pregnant. She notified the state of her pregnancy, and her coverage was changed to Healthy Start with MassHealth Limited. Her REVS message now lists Healthy Start and Limited, and her Commonwealth Care coverage is also listed until the last day of the month. This is because dis-enrollment from a Commonwealth Care plan can't take effect mid-month. This example explains why providers might sometimes see patients with other coverage, along with their Commonwealth Care coverage. Women who become pregnant could benefit from reporting the pregnancy to the state, since the fetus is then counted in the state's calculation of household income and may qualify them for a more comprehensive program. In this case, the patient no longer has her Commonwealth Care co-pays and premiums during her pregnancy.

-Adapted from “Operational Updates: MassHealth, Commonwealth Care, Commonwealth Choice, and HSN” , e-mail from Kim Simonian, MPH, Partners HealthCare Community Benefit Programs, December 02, 2007.

12/07