Health Announce: Dec. 9, 2024

Snowy Greetings!  

Massachusetts got its first significant snowfall this winter. (Some areas in Western Mass saw almost 10 inches!) Even if the snow didn’t stick by you, there is something magical about snowfall and how it reduces stress and anxiety.  You can get a similar effect with twinkly lights strung around your home!  For a real mood boost, get outside and visit one of the many light displays in Boston and around Massachusetts. 

Why are we talking about mood boosters? Several weeks ago, Health Announce pledged to share resources and strategies for preparing for and getting through approaching tough times.  Our primary focus is on action – what we can do to make a difference.  And we also know that our concerns and fears of what's coming are reasonable given the policy proposals currently circulating and what happened during 2016-2020.  So we need to take care of ourselves and each other to effectively tackle the challenging work ahead.

Topics for this week’s Health Announce:

1. Health Care Workgroup (HCWG) this Wednesday!

2. Upcoming webinar on Enhancing Privacy in the Post-Dobbs Era, hosted by the Massachusetts Health & Hospital Association (MHA).

3. CMS publishes updated 2025 financial eligibility standards for Medicaid SSI and MSPs.

4. USDA provides clarification that Medicare Advantage Supplemental Payments do not count for SNAP purposes.

5. CMS releases guidance letter: Protecting Medicaid Beneficiaries Against Impermissible Fraud and Abuse Sanctions.

6. Welcome to Michael T. Caljouw, the New Health Insurance Commissioner!

Be well,

Jennifer Hotchkiss Kaplan

Senior Health Law Attorney

Massachusetts Law Reform Institute

Health Care Workgroup (HCWG) this Wednesday!

This week, the HCWG meets on Wednesday, December 11, 2024, at 3 pm. While 2025 will likely require advocates to move into a defensive posture to preserve and protect access to health care, we are planning a forward-looking, action-oriented discussion to prepare for potential federal and state budget cuts and other policy changes that limit access.  Before tackling the hard issues, we will start in gratitude and awe of a respected colleague’s last HCWG with us: Nancy Lorenz retires from GBLS after decades as a dedicated and powerful attorney and advocate.  Please come join the celebration and help us toast Nancy!  The meeting link should already be in your calendars, but reach out to me (jkaplan@mlri.org) or Kate (ksymmonds@mlri.org) if you need any assistance.

Upcoming webinar on Enhancing Privacy in the Post-Dobbs Era, hosted by the Massachusetts Health & Hospital Association (MHA).

On Wednesday, December 18, 2024, MHA is providing a webinar on federal and state efforts to secure and protect patient care and health information.  Beyond the explicit relevance to individuals seeking reproductive care, this issue also potentially implicates the rights of our immigrant, LGBTQ+, and trans clients. Register here.

CMS publishes updated 2025 Medicaid financial eligibility standards for SSI and MSPs.

The Centers for Medicare and Medicaid Services (CMS) released the 2025 Medicaid financial eligibility standards for Supplemental Security Income (SSI), Medicare Savings Programs (MSPs).  Also, CMS published the resource and cost-sharing limits for Medicare Part D Low-Income Subsidy (LIS).  The National Council on Aging has a resource on Medicare Saving Programs Eligibility and Coverage.  Here are some useful, Massachusetts-specific bits:

• The January 1 update in the SSI Federal Benefit rate is used to set the upper income level for PACE and the 9 adult HCBS waiver programs, which are three times the SSI federal benefit rate (FBR). That upper income limit is currently $2829 per month. On January 1, 2025, it will go up to $2901 per month.

• Spousal Impoverishment standards will also go up on January 1, 2025. When a married nursing home resident applies for MassHealth, the spousal impoverishment standards are used to determine how much of the couples' combined resources can be protected for support of the community spouse and how much of the institutional spouse’s income can be used for the community spouse’s support.

• Though CMS has updated the resource standards for the Medicare Savings Program (MSP), resource standards are longer relevant in Massachusetts because our MSP program has disregarded all resources since March 1, 2024.

USDA provides clarification that Medicare Advantage Supplemental Payments do not count for SNAP purposes.

On December 5, 2024, the US Department of Agriculture (USDA) Supplemental Nutrition Assistance Program (SNAP) published a policy memo clarifying that state agencies must exclude all Medicare Advantage (MA) supplemental benefits when determining income for purposes of SNAP eligibility.  In short, because CMS approves supplemental benefits as “primarily health related,” they do not represent a gain or benefit to the household under federal regulation, and therefore are not subject to the restriction on normal living expenses. 

CMS releases guidance letter: Protecting Medicaid Beneficiaries Against Impermissible Fraud and Abuse Sanctions.

CMS released on December 5, 2024, a letter (attached below) to state Medicaid directors clarifying that – except for narrow exceptions – “federal law does not permit state Medicaid agencies to recoup funds from, or lock-out from Medicaid coverage, a beneficiary who the state determined abused or defrauded the Medicaid program.”  The guidance discusses the impermissible administrative sanctions, as well as under what narrow circumstances sanctions or penalties for beneficiary fraud and abuse are allowed.  For example, inaccurate determinations that a beneficiary is eligible for Medicaid do not fall within the scope of fraud or abuse solely because of their inaccuracy. Accordingly, state Medicaid agencies cannot retroactively terminate coverage to the date of the inaccurate determination. 

At the core of the CMS guidance is the protection of beneficiaries’ due process rights.  Once a person is found eligible for Medicaid, they are entitled to coverage until the Medicaid agency makes a determination of ineligibility and provides at least 10-days advanced notice and fair hearing rights: these rights prevail even if the eligibility determination was made in error.

Welcome to Michael T. Caljouw, the New Health Insurance Commissioner!

Finally, we extend a warm welcome to Michael T. Caljouw, newly appointed Commissioner of the Division of Insurance (DOI). In his role, Commissioner Caljouw also serves as an ex officio member of the Health Connector Board.  DOI is an agency tasked with overseeing and monitoring the solvency of the insurance industry and the companies and providers licensed to do business in Massachusetts.  Additionally, DOI promotes consumers’ informed decision-making about their insurance options by providing accurate and unbiased information about policy decisions, plan types, and available insurers.