The FY04 budget authorizes DMA to charge premiums and co-pays to MassHealth recipients. DMA released draft regulations, final rules are expected shortly. Premiums should go into effect November 1st.

DMA will charge premiums based on a sliding scale to the extent permitted by federal law (for members over 133% FPL). Premiums will be applied to both children and adults on MassHealth. Expected to affect 17,000 households.

• Adults: $15 per month per family group
• Children: $12 per month for one child; $15 per month for 2 or more children

New groups that will be charged these premiums are:

• Children 7 -18 with family income between 134-149% FPL
• Disabled adults with income between 114-133% FPL
• HIV+ individuals with family income between 101-149% FPL
• Disabled working adults on CommonHealth with income between 101-149% FPL
• Other disabled adults on CommonHealth with income between 134-150% FPL

Advocacy Tips:

• Pregnant women and children under age 7 are exempt.
• Watch for cases where children turn 7, family neglects to pay premium, and all children are terminated accidentally.
• DMA will charge up to $3 co-pays for MassHealth services (excluding mental health and substance abuse services) and up to $3 co-pays for prescription drugs. DMA has not yet decided whether co-pays will be applied to children on MassHealth.
• The timetable for operationalizing these co-pays is still unclear.
• Not all assets count under the proposed rules. Cash, bank accounts, and stocks almost always count. At least 1 car and the house of primary residence do not count. The final rules may differ from the rules that have been proposed.