Health Update Jan 18, 2022

1.      How the declaration of a continuing COVID-19 Public Health Emergency (PHE) does and doesn’t affect MassHealth

On Jan. 11, 2023 the Secretary of HHS extended the COVID-19 Public Health Emergency by another 90 days until mid-April. 

However, certain important Medicaid protections that were originally tied to the COVID-19 Public Health Emergency (PHE) declaration, are no longer tied to the end of the PHE, and now have fixed end dates. These changes were made by the Consolidated Appropriations Act enacted on Dec. 29, 2022 and are described in this Jan 5, 2023 Information Bulletin from CMS.

·         March 31, 2023. Medicaid continuous coverage for individuals enrolled on or after March 18, 2020 ends on March 31, 2023. On April 1, 2023 MassHealth will take 12 months to initiate renewals for its MassHealth members to see if they still qualify for coverage. 

·         Dec.31, 2023. Enhanced federal matching funds (in declining percentages) remain available to states until Dec 31, 2023 provided they comply with “Maintenance of Effort” requirements-

o   No changes in benefit eligibility rules, methodologies and procedures that are more restrictive than those in effect in Jan. 1, 2020,

o   No increases in premium over amounts on Jan. 1, 2020.

·         There are new requirements to assure transparency and accountability for “unwinding” continuous coverage.

Other MassHealth policies put in place during COVID are still tied to the duration of the PHE, but in different ways:  

·         Some of these policies were always at the option of the state and Massachusetts can elect to make them permanent or end them regardless of the duration of PHE. For example, during the PHE, MassHealth has chosen not to use the 1115 waiver authority that allowed it to deny people under 65 three month’s retroactive coverage. The state is free to continue to provide three month’s retroactive coverage to everyone eligible regardless of age after the PHE ends. 

·         Other policies required specific permission from CMS and are scheduled to expire when the PHE ends or in some cases, within a certain period of time after the PHE ends, or the state might choose to end them earlier. There may be other ways that MassHealth can continue these policies after the PHE ends, but it would require further authorization from CMS. 

·         However, some policies are set out in state or federal statutes and the end date can’t change unless the statute is changed. For example, ARPA requires that Medicaid continue to provide COVID-19 testing, treatment and vaccine administration at no cost to members until the end of the first quarter that ends 12 months after the end of the COVID-19 PHE.

More information should be available soon. MassHealth must file its unwinding plan with CMS by Feb 15, and we should soon have the unwinding toolkit that it has been working on in collaboration with the Health Connector and with our colleagues at Health Care for All. Meanwhile, the most recent guidance from MassHealth was this August 2022 Eligibility Operations Memo 22-10, including the 120 day appeal period authorized by CMS during the PHE.

 

2.      What health advocates can do to help SNAP beneficiaries facing a big drop in benefits after March 2023

Extra COVID SNAP ending for all ~640,000 SNAP households on March 2 - resources from DTA in 15 languages 

Since April 2020, people on SNAP have received an extra federal SNAP amount, but it will soon be coming to an end. The final extra SNAP payment will be on March 2, 2023. After March 2, families will get their normal SNAP amount but not the extra benefit amount. All households will see a cut of at least $95 a month as a result - many will face an even greater cut. Some may be able to qualify for more SNAP benefits under the normal rules IF they let DTA know about decreases in income, or increases in expenses that are used to calculate the amount of SNAP benefits. These expenses include shelter costs, medical expenses for 60+/disabled, and child/adult care costs. 
 

DTA has created one page flyers in 15 languages explaining 3 key things: 

1. The last extra benefit will be on March 2 

2. How to claim deductions and report changes to maximize SNAP benefits

3. Where to get other resources or help
 

You can help get the word out to your patients, clients & members by distributing the flyers or using other resources  that DTA has put together in a comprehensive toolkit

DTA has more information on its website here: Mass.gov/ExtraCOVIDSNAP. 

You can also help people with disabilities or age 60 or older to report medical expenses.. Attached is the DTA self-declaration form. It includes some out of pocket expenses that MassHealth doesn’t cover like mileage for getting to medical appointments by personal car.

 

We encourage sharing DTA’s fliers with as many low-income households as possible. 

 

3.      HHS releases Federal Poverty Level amounts for 2023 and what it means for MassHealth

 

On January 17, 2023, HHS posted the  2023 Federal Poverty Level (FPL) amounts in advance of their official publication in the Federal Register. They are posted here.

 

The FPL is adjusted each year by a dollar amount and varies by household size. For 2023, the annual FPL for 1 person increased by 7.3% from $13,590 to $14,580, the FPL for a 2-person household increased by 7.7% from $18,310 to $19,720. 

 

The upper income limit for most of the programs administered by MassHealth are based on the Federal Poverty Level which MassHealth updates on March 1 each year. 

 

MassHealth doesn’t take into account January cost of living adjustments in Social Security income until March 1 when the FPL is adjusted. In 2023 the Social Security Cost of Living Adjustment was 8.7%. This higher percentage increase for the Social Security COLA compared to the FPL adjustment means that more households receiving Social Security Retirement, Disability or Survivor’s benefits may no longer be financially eligible for MassHealth in 2023.

 

However, this March 1, 2023, the Medicaid continuous coverage protection will still be in place and no one should lose benefits on March 1, 2023. Further, CMS has said that states must provide everyone an opportunity to complete a full renewal before benefits can be terminated after March 31, 2023. 

 

Also, two important policy changes took place in 2022 in Massachusetts: The expansion of the CommonHealth program that was implemented in Dec 2022 by Eligibility Operations Memo 22-17, and the expansion of the Medicare Savings Programs that was required by legislation enacted in July 2022 but has not yet taken effect. Both these changes will reduce the number of people otherwise losing benefits after their post April 1, 2023 renewal, just based on different ways of measuring cost of living adjustments. More to come on the status of the MSP expansion which we expected to take effect Jan 1, 2023 but did not.

 

The MassHealth PACE program and most of the Home and Community-Based Services waiver programs apply an upper income limit that is not based on the FPL but on three times the federal benefit rate for SSI. This income standard took effect on Jan. 1, 2023 and went up by 8.7% from $2523 per month to $2742. 

 

4.      New MassHealth Regulations & PSI Form: 

·         Effective Jan 1, 2023, MassHealth improves the scope of the behavioral health services available to MassHealth beneficiaries who are not enrolled in any kind of managed care. For the first time, Licensed Clinical Social Workers can now participate as providers in the Fee for Service system/MassHealth network and Psychologists can now participate as providers of therapy services. These rule changes were released in Jan 2023 Transmittal Letters posted here.

·         MassHealth also amended its Fair Hearing regulation in December, 2022 permanently changing the appeal period for most appeals from 30 to 60 days. These rule changes were released in a Dec 2022 Eligibility Letter posted here.

·         The official source for state regulations is the Massachusetts Register. The Dec 23, 2022 and Jan 6, 2023 Massachusetts Registers included permanent changes to regulations in 130 CMR that have not yet been distributed as Eligibility Letters or Transmittal Letters. They include permanent changes to the pooled trust rules in 130 CMR 520 that went through proposed rule-making back in 2016. The Massachusetts Register is available on the state library website here.

·         MassHealth has also revised the Permission To Share Information (PSI) Form, but in case you hoped it might be less confusing than the old form, it’s not. For example, even though the Health Connector honors the PSI form, it still is not co-branded with the Health Connector logo. Old forms will not be accepted by MassHealth after Feb 1, 2023. The new PSI and other Member Forms (including a new form that can be used for reporting self-employment income) are posted here.