As discussed previously in this space, MassHealth has recently instituted premiums for certain members who have incomes above 133% of FPL. These members have the right to appeal premiums on the basis of economic hardship. Waivers or reductions may be granted for periods up to 6 months.

The process is as follows:

• Members must call the Member Premium Billing Office at 1-888-426-9901 and ask for a hardship exemption. (Although the form will be available publicly, DMA urges members to call the Billing Office to request the form, so that they may log in the member's request and recognize members who may be facing termination. This should allow them to halt the termination.)
• DMA reviews the recipient's/family income in order to confirm that they are subject to premiums.
• DMA mails the recipient a form, asking about the nature of their hardship.
• The member sends in the completed form.
• DMA reviews the form and request additional information if needed.
• DMA issues a written decision that can be appealed through the regular appeals process. A decision can be expected within 30 days.

DMA would not agree to make broad exceptions for groups of members, such as members living in homeless shelters. The hardship form looks for a member's short-term crisis situation, as opposed to general inability to pay due to every day life circumstances.

Note: premiums are waived while the hardship waiver is pending, but if DMA does not approve the request, then the member owes premiums retroactively to cover the time the member was awaiting a decision.

Members who fail to make two months of premium payments will be terminated. Members can avoid termination by working out a payment plan. Members have up to 30 days to appeal the termination, but need to file within 10 days to preserve their coverage while the appeal is pending.

If a member is determined to be eligible again within 24 months, the member must pay his/her outstanding premium payments before re-enrolling in MassHealth.

There is no process in place to deal with premium payments that are returned to DMA undeliverable. It will be extremely important for members to submit any address changes to DMA. It is possible that a member might never receive a bill, and will still be terminated. DMA expects to see a number of cases closed for "whereabouts unknown" once premiums are implemented.

Advocacy Tips:

Although this form seems to seek information about an immediate crisis that is causing financial hardship of a limited duration, members should not be deterred from applying on the basis of general inability to pay due to the economic pressures of living in a low income household and meeting basic needs. There are no criteria for approval of requests yet (200 forms have been submitted but none reviewed yet), so it may be worth urging members to apply and see what happens.

DMA urges members to call their Billing Office to request this form, even though the form is publicly available. If a member calls to request the form, DMA will log in the request and if the member comes up for termination, DMA will be able to prevent their termination by noting they are in the waiver review process. For patients who have difficulty navigating the system, it may make sense to call to request the form and also fill out the form while you have the client in the office. Forms are available from the CRC and shortly on the department's website.

Watch for patients with long inpatient stays who may fall behind on premium payments and face termination during a hospital stay. (Although MassHealth won't pay for days in the hospital over 20 days, the member still might need MassHealth coverage for a device, discharge planning, or pharmacy coverage upon discharge. And keeping someone on MassHealth is easier than re-enrolling them at a later time.)

-Thanks to Kim Simonian, MPH, of Health Access & Community Partnerships, Partners Community Benefit Programs for forwarding this information and the advocacy tips.