Health Announce: Oct. 29, 2024
Today's sunrise happened at 7:12 am. When we started this month, sunrise occurred at about 6:45 am; when November begins on Friday, sunrise will be at 7:18 am -- and then jump back to 6:20 am on Sunday. Daylight saving time ends, and we return to standard time, with the bonus of an extra hour of sleep! If the whole idea of daylight saving time bugs you, you can blame George Vernon Hudson, the New Zealand entomologist who invented the concept because he wanted more time to hunt for insects after work.
This week, Health Announce is primarily focusing on open enrollment at the Health Connector, which begins Friday. Topics this week:
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New enrollment freeze for CCA beginning Nov. 1, 2024.
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“Disability Evaluation Services Overview and MassHealth” virtual meeting by MTF tomorrow.
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Open enrollment for 2025 coverage begins November 1, 2024.
Be well,
Jennifer Hotchkiss Kaplan
Senior Health Law Attorney
Massachusetts Law Reform Institute
New enrollment freeze for CCA beginning November 1, 2024.
Commonwealth Care Alliance (CCA) is facing financial challenges and, per a directive by MassHealth, will be suspending new enrollments beginning on November 1, 2024. This impacts One Care and SCO (notably, the majority of CCA’s enrollees are in One Care). MassHealth has assured advocates that other health plan providers are prepared to take on the additional demand. No other information is available at this time.
"Disability Evaluation Services Overview and MassHealth" virtual meeting by MTF tomorrow.
On October 30, 2024, at 2:00 pm, the Massachusetts Health Care Training Forum (MTF) is holding a virtual meeting called “Disability Evaluation Services Overview and MassHealth.” The presentation covers the MassHealth disability evaluation process, as well as MassHealth disability reviews. Register here.
Open enrollment for 2025 coverage begins November 1, 2024.
Open enrollment at the Health Connector runs from November 1, 2024 to January 23, 2025. During this time, people can sign up for 2025 coverage or change their current plan. If people want coverage to begin January 1, 2025, they must apply, pick a plan, and make their first payment (if they have one) by December 23, 2024. The Connector will be using the 2024 federal poverty level standards for 2025 coverage. And people without insurance still have until November 23, 2024, to apply for coverage starting December 1, 2024, based on the 2023 federal poverty level standards if they have a “qualifying event.”
People can get an idea of what financial help they may qualify for and what plans are available by using this screening tool. New applicants can create an online account and apply at https://www.mahix.org/
Continuing in 2025
In 2025, the upper income limit for ConnectorCare is 500% of the federal poverty level for coverage with no deductible and for premium charges and copays based on income. Also in 2025, enhanced federal subsidies for the tax credit that brings down premium costs are still in effect.
New in 2025
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An expanded definition of “lawful presence”
New in 2025 for certain immigrants is an updated definition of “lawful presence” for use in state-based Marketplaces. This will enable young people with DACA (may have code C-33 on their work authorization cards) and certain other immigrants with income of 300-500 percent of poverty to qualify for ConnectorCare, and those with higher incomes to use the Connector to shop for full cost insurance. The Connector has already identified 350 individuals with DACA who had applied in 2024 and will be notifying them of the change. DACA and other immigrants subject to the new Marketplace definition with income of 300% FPL or less will still qualify for MassHealth Family Assistance as PRUCOL. Online applications will not reflect this change in real time, but the online system should show the correct result the next day. (Note: Sixteen states have filed a legal challenge to this new federal definition).
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All the same ConnectorCare plans are returning in 2025, but there have been changes in 2025 plan service areas and networks
Among the changes are an expansion of the Fallon service area, and the Tufts Direct plan will no longer include UMass Memorial Hospital or Boston Children’s Hospital in its network for 2025.
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Resumption of IRS data-matching for “failure to reconcile”
For coverage in 2025, the Health Connector will once more be checking to see if people who received premium tax credits in the past have filed taxes and completed the special tax form to “reconcile” the amount of their premium tax credit. People who have “failed to reconcile” for two years or more will not be eligible for premium tax credits in 2025. Affected individuals can still enroll for 2025 based on an attestation that they intend to file for past years but must do so within 90 days to avoid termination.
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Other changes
The Connector has hired a new company called Automated Health Systems (AHS) to run its Call Center, however it will be overlapping with continued service from the current Call Center company Accenture. Also expect to see new options for making payments and an expanded list of acceptable documents accepted to verify identity in order to create an online account, as well as examples of more acceptable documents to verify an eligible immigration status.
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A glitch affecting about 400 ConnectorCare members redetermined this fall
About 400 ConnectorCare members in their 60s have gotten erroneous notices that they are eligible for CommonHealth based on a system defect that has recorded them as disabled even though they are not. CommonHealth provides coverage to people with disabilities with income too high for MassHealth Standard and charges a sliding scale premium starting at 150% of the poverty level. The same glitch has affected some older adults on MassHealth. MassHealth and the Connector are aware of the glitch and are working on fixing it and getting people into the right coverage. We don’t have any more information currently.