Health Update May 12, 2023

Yesterday May 11, 2023 marked the end of the COVID 19 Public Health Emergency (PHE) first declared over three years ago. With the end of the PHE certain federal and state policies affecting access to health care are ending, while others have been extended or changed.

MassHealth Policies

All Provider Bulletin 367: Coverage and Reimbursement Policy Updates for Services Related to COVID-19 after the Expiration of the Federal Public Health Emergency (May 2023) Including -

• Starting May 1, 2023 and continuing through March 31, 2024 MassHealth is suspending all pharmacy copays except for children enrolled in CMSP. 
• COVID 19 vaccines, testing and treatment 
  • Vaccines will continue to be free for all MassHealth members including for MassHealth Limited from MassHealth participating providers and plans and from Health Safety Net (HSN) providers.
  • Testing will continue to be free for all MassHealth members from MassHealth participating providers and plans and from HSN providers, but-
    • Free COVID testing kits available without prior authorization will change from 8 per month to 2 per month starting July 2023
    • For people with MassHealth Limited and HSN, testing will only be available through HSN providers (including 2 free testing kits per month)
  • Treatments for COVID-19 including prescription drugs such as paxlovid and molnupiravir will continue to be covered for all MassHealth members including for MassHealth Limited and from HSN providers

Eligibility Operation Memo 23-13 (April 2023): MassHealth Policy Updates to Support Return to Normal Business Operations (April 1, 2023 – March 31, 2024)

MassHealth Redeterminations. In this Memo MassHealth sets out the rules it must follow during the one-year period it has to return to normal operations after the end of the federal continuous coverage period in place from March 18, 2020 to March 31, 2023. 

• MassHealth acknowledges that “Federal guidelines determine when we can close or downgrade coverage (or take “adverse action”), and we must follow these guidelines during the redetermination period.” This is important because there is  extensive federal guidance governing the redetermination process.
•  It also announces eligibility policies in place at least until March 31, 2024 including:
  • Continuing Hospital Presumptive eligibility for people age 65 or older or needing nursing home care
  • Disregarding from countable assets the amount of certain unspent income related to policies in place during the COVID-19 PHE. 
    • The memo provides no information at all about how these exempt assets, most of which will be mingled with other funds in bank accounts, will be identified at the time of application or renewal.
    • It also states that unspent Economic Incentive Payments (also called stimulus payments or recovery rebates) paid by the IRS are never counted as assets. This is correcting EOM 22-14 (Nov 2022)  which stated that such unspent funds are only exempt during the PHE.
• At the May 11, 2023 Health Connector Board Meeting MassHealth reported that since April 1, they had selected 70,000 households for renewal most of whom would not be getting determinations until May.
• The Connector staff reported that since April 1 over 12,000 people have already been terminated from MassHealth and been found eligible for the Health Connector, most because they “proactively” renewed early online before they had been selected for renewal and that 64% or 7,790 had not selected a plan or enrolled in coverage with the Health Connector.
•  PLEASE LET US KNOW IF YOU ARE SEEING APRIL & MAY TERMINATIONS: vpulos@mlri.org and ksymmonds@mlri.org

Eligibility Operations Memo 23-11(April 2023): Ending Temporary Eligibility Policies Established during the Federal Public Health Emergency (COVID-19 Pandemic)

MassHealth ended the following policies April 1, 2023:

• Self-Attestation: “MassHealth will no longer accept self-attestation to verify eligibility factors except as described in MassHealth regulations.” The memo does not mention that the Member Forms Library includes the following self-attestation forms still available to verify eligibility factors: A general Attestation Form to Verify Income,  a Verification of Self-Employment Income form, an Affidavit to Verify Zero Income, an Affidavit to Verify Massachusetts Residence, and an Affidavit to Verify Incarceration Status.
• CommonHealth Deductible waiver: “Hardship waivers for the one-time deductible to establish eligibility for MassHealth CommonHealth will no longer be available.” The memo does not mention that in Dec 2022 and pursuant to the most recent extension of the 1115 Demonstration, there is no longer a deductible requirement in the CommonHealth program. EOM 22-17 Changes to Streamline CommonHealth Eligibility for Adults.
• 3-months Retroactive Coverage:  Pursuant to the 1115 Demonstration, MassHealth will resume its waiver of 3 months retroactive coverage for non-pregnant adults 19-64, authority it had elected not to exercise for the last 3 years.
• Hospital-determined Presumptive Eligibility (HPE) Periods “Members will be able to obtain only one HPE determination within a 12-month period.” 
• Extended Timeframe to Request Fair Hearings. “Members will have 60 days to request a fair hearing for concerns related to member eligibility.” The memo does not mention that the 30-day appeal period in the regulations had been temporarily extended to 120 days during the PHE. Any decisions made prior to April 1 should still be governed by the 120-day appeal period. In Dec 2022 MassHealth amended its regulations to change the 30-day appeal period to 60 days. 130 CMR 610.015(B)(1). (Most appeals  now have 60 days, but under the rule, appeal periods range from 14 days to 120 days depending on the nature of the adverse decision). 

Other recent MassHealth Eligibility Operations Memos

Our friends in the elder law bar were happy to see that MassHealth clarified that the restrictions on people 65 and older creating a pooled trust will not take effect until March 1, 2024, ,EOM 23-15: Eligibility Changes Concerning Transfers to Pooled Trusts and that MassHealth has returned to valuing life estates and remainder interests in accordance with IRS methods . EOM 23-12: UPDATED: Calculating the Value of Life Estates and Remainder Interests

Federal policies

HHS Fact Sheet: End of the COVID-19 Public Health Emergency (May 9, 2023) Including information on how continued access to free COVID 19 vaccines, testing, and treatment may change.

HHS Fact Sheet: Telehealth Flexibilities and Resources and the COVID-19 Public Health Emergency (May 10, 2023) Including temporary extensions of flexibilities related to treatment of Opioid Use Disorders and other controlled substances pending permanent rule-making changes by SAMHSA and DEA.

Massachusetts

WBUR Health Newsletter (updated May 10, 2023), What the end of the federal public health emergency means in Massachusetts Including, “Private health insurers will no longer be required to provide free rapid antigen tests — and Massachusetts’ biggest insurance companies say they will stop doing so.”