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MLRI MassHealth/Connector Income Guidelines for Open Enrollment beginning November 1, 2017

MLRI
Attached is a revised MLRI MassHealth Income Chart, revised to reflect the 2017 FPL levels for the Connector programs. 2017 FPL income guidelines are effective in ConnectorCare during the January through December 2018 enrollment period.  Open Enrollment for 2018, begins on November 1st and runs…

Reference Guide to Federal Medicaid Statutes & Regs

MACPAC
Helpful on-line research tool from the Medicaid and Chip Payment and Access Commission (MACPAC) listing topics/issues with corresponding provision in Medicaid T. XIX and federal regulations. 

Oct 20 CMS Comment Deadline on MassHealth 1115 Amendments

vicky pulos
On Sept. 8, 2017, EOHHS submitted a request to CMS to amend the 1115 Waiver to include a wide-ranging set of MassHealth eligibility and benefit cuts. Comments on the proposed changes must be filed with CMS by Oct. 20, 2017. Attached is a Table prepared by MLRI summarizing the July proposal to amend…

Action Alert: September 1 Comment Deadline on Ending Non-emergency transportation in CarePlus & Provisional Income Eligibility for Adults in MassHealth and the HSN

MLRI and others
MassHealth filed a proposal to end provisional income eligibility for adults in MassHealth and the Health Safety Net (except adults who are pregnant, HIV+ or in treatment for breast or cervical cancer) with a target date of October 2017.  This will delay enrollment for adults whose income is…

Advocates' Comments to EOHHS on 1115 Proposal

MLRI and others
In July 2017 EOHHS released for public comment proposed amendments to the MassHealth 1115 demonstration. The proposals among other things would lower the income standard for parents/caretakers and other non-disabled adults, deny MassHealth to non-disabled adults with access to Student Health…

30A Complaint for BOH Failing to Vacate Dismissal

Nancy Lorenz
This is a redacted Complaint seeking judicial review of the Board of Hearings final action denying the appellant's motion to vacate the dismissal of his appeal. The issue was whether he had good cause for his failure to appear. His counsel, Nancy Lorenz of GBLS, reports that the agency agreed to…

Fact sheet & Letters to FY 18 Conference Committee on Last Minute MassHealth Reform Proposals

MLRI, ACT Coalition
On June 20, the Governor asked the conference committee to include a package of reforms in the budget for the fiscal year staring July 1, 2017 including damaging cuts to MassHealth eligibility and benefits.  Attached is a two- page fact sheet with our critical concerns and…

Daley v. Secretary of EOHHS

Gants, C.J.
SJC decision reversing the MassHealth board of hearings  in two cases concerning eligibility for nursing facility care. In both cases the applicants had transferred ownership of their homes to an irrevocable trust. in one case retaining a life estate and in the other retaining the right to use…

Modeling the Impacts of the American Health Care Act on Massachusetts

Urban Institute
A May 23, 2017 study by the Urban Institute  commissioned by the Blue Cross and Blue Shield of Massachusetts Foundation in its role as a co-convener of the Massachusetts Coalition for Coverage and Care  projects devastating consequences for the Commonwealth if the House-passed version of the…

Letters to Congress on CHIP and the AHCA

Gov. Baker
Attached are two recent letters signed by Gov Baker. One letter dated May 11, 2017 is from the National Governor's Association, co-signed by Gov Baker as vice chair  of the Health & Human Services Committee  to Congressional leaders urging them to reauthorize funding for the…

AG Guidance: Information for Massachusetts Health Care Providers Regarding Immigration Enforcement

Mass. Attorney General
The AG’s Office issued  guidance following inquiries from health care providers and public school officials about the impact of federal immigration policies and executive orders on patients and students.“Parents should never be afraid to send their children to school, and people…

Preliminary Look at How the House Repeal and Replace Bill Could Affect MassHealth and ConnectorCare

Vicky Pulos
Attached is MLRI's summary of some of the most worrisome features of the initial version of the House bill to repeal and replace key features of the Affordable Care Act (as of March 13, 2017).

Medicaid Defense: Fact Sheets on Medicaid & the ACA in Mass

various
The latest proposal from House Republicans is to repeal the Affordable Care Act's Medicaid expansion and drastically reduce Medicaid funding by converting it to a Block Grant or a Per Capita Allotment. Attached are fact sheets on the importance of Medicaid in Massachusetts, and the harm that…

Questions and Answers on Mass Health and Connector Care

Massachusetts Law Reform Institute
This handout, with commonly asked questions about Mass Health and Connector Care, was produced by the Massachusetts Legal Assistance Corporation.

Getting Through and Being Heard: Limited English Proficiency and MassHealth

Laura Spark and Vicky Pulos
Attached is the report of a survey of bilingual enrollment assisters and advocates conducted by MLRI on the experience of Limited English Proficient  (LEP) MassHealth applicants and members attempting to communicate with MassHealth by telephone. The survey results identified multiple barriers…

Comments on Proposed Transportation Rules

MLRI and 9 others
Comments filed by MLRI and 9 other provider and consumer advocacy organizations recommending improvements in MassHealth transportation proposed regulations.

New Health Income Chart for Use in Open Enrollment Beginning November 1st, 2016

MLRI
Attached hereto, please find a new income chart for use in ConnectorCare and Qualified Health Plans for Open Enrollment which begins November 1st, for effective coverage beginning in January 2017.  These new numbers are based on the 2016 Federal Poverty level and are used for benefits for the…

Info for ConnectorCare members who didn't file a 2015 federal tax return

Vicky Pulos
This 2-page flyer is intended for people who received ConnectorCare in 2015 but did not file a federal tax return for 2015. They will not be eligible for ConnectorCare in 2017 unless they file their 2015 return along with a form to account for the advance premium tax credits that are part of…

Representing Clients in MassHealth Cases

Vicky Pulos
Powerpoint from June 2016 training for legal aid and pro bono lawyers on Reprenting Clients in MassHealth Cases. 

HHS 1557 Nondiscrimination Regs

Department of Health and Human Services
45 CFR Part 92 Nondiscrimination in Health Programs and Activities Summary: This final rule implements Section 1557 of the Affordable Care Act (ACA) (Section 1557). Section 1557 prohibits discrimination on the basis of race, color, national origin, sex, age, or disability in certain health…

MLRI Comments on MassHealth Draft Language Access Plan

Vicky Pulos & Teresita Ramos
Attached are MLRI comments on MassHealth's Draft Language Access Plan. The Medicaid agency is required by law to provide meaningful access to its services to individuals who are not proficient in English. A language access plan should asses the language needs of the eligible population and…

Letter to Secretary Opposing Managed Care Lock-In

Vicky Pulos and others
This is a letter signed by legal aid and disability rights organizations to Sec. Sudders opposing the administration's proposal to go to a 12-month lock in for MassHealth beneficiaries who enroll in a Managed Care Organization. 

MassHealth Income Guidelines March 2016

MLRI
Here are the March 1, 2016 MassHealth Income Guidelines.  Two files attached: MLRI MassHealth Income Guidelines MassHealth FPL-Desk Guide

Alert: Health Safety Net Cuts: Public Hearing Feb. 26, 2016

Vicky Pulos
EOHHS has released proposed rules that will significantly restrict eligible services in the Health Safety Net as early as April 1. The rules can take effect only after a public notice and comment period. The attached FAQ  describes the HSN program, the proposed cuts, the rationale for the cuts…

2016 MassHealth Orthodontia Settlement

Misc
A group of orthodontist & their patients sued MassHealth for having unduly restrictive medical necessity criteria for approving braces for children & youth under age 21. The case resulted in a settlement changing MassHealth policies. Attached is a copy of a Jan 2016 transmittal letter making…

Comments on Proposed Regulations on Nondiscrimination in Health Programs

MLRI and MHLAC
On Sept. 8, 2015, HHS published proposed rules implementing  section 1557 of the Affordable Care Act regarding nondiscrimination in health programs.  Attached are two comments on the proposed rules one submitted by  MLRI and one by MHLAC. It is not too late to comment, the comment…

2016 ConnectorCare Materials

Connector
The Connector has updated flyers and other informational materials about ConnectorCare for 2016 coverage.   Follow the link to their "Resource Download Center" for documents that include the 2016 Guide to ConnectorCare; a Guide to subsidized plans explaining how advance…

FAQ: MassHealth - NEW Coverage of Applied Behavior Analysis Services for Children with Autism Spectrum Disorder

Mass Advocates for Children and MLRI
The Autism Omnibus Act requires MassHealth to cover medically necessary ABA services for children with autism under age 21.  ABA services are now available to MassHealth members. The attached “Frequently Asked Questions” explain how to get coverage now through the…

"Workaround" for Disabled Adults with MAGI over 133% FPL

Vicky Pulos
This memo summarizes the circumstances in which the new eligibility and enrollment system will not be able to make an accurate determination for certain disabled adults, and a "workaround" is in place to eventually make the correct determination.  

Applied Behavior Analysis for MassHealth members under age 21

MLRI
Applied Behavior Analysis for MassHealth members under age 21.  ABA providers can apply to MassHealth to enroll as a provider and get prior authorization to provide services NOW. Also, for children and young adults (under 21) enrolled in private insurance with the Partnership for their…

Immigrant Eligibility Alert-Data Entry Errors

Vicky Pulos, MLRI
We are still working on tracking down the source of persistent eligibility errors affecting immigrants. It looks like one source of the problems may be when information from paper application forms are entered into the computer by the state. In this alert, we show what the computer screen menus…

Web link to Browse for Coverage from the Connector

Connector
Do you have more than one option for insurance coverage and want to check out what is available through the Connector before you actually apply? You can both get a rough idea whether you may qualify for help reducing the costs of insurance purchased through the Connector and compare the costs of…

ConnectorCare-Basic Info Needed to Select a Plan

Health Connector
ConnectorCare is the name for those private plans purchased through the Health Connector with the lowest premium & cost sharing for individuals with income that does not exceed 300% of the poverty level. It is comparable to the former Commonwealth Care program.  Once found eligible for…

Update on People Losing Health Coverage

Vicky Pulos MLRI
This updated April 10, 2015 Table shows the two different groups of people who had health coverage end recently or will be getting MassHealth termination notices soon.  Both groups need to reapply for coverage but they have different deadlines and different remedies if they miss their…

Alert for Legal Immigrants Getting Connector Denials, April 2015

Vicky Pulos
Please help us identify lawfully present immigrants who were incorrectly denied benefits by the Connector & received only MassHealth Limited or Health Safety Net from MassHealth.    Attached is an alert for affected immigrants including information about how to get legal…

Alert to legal aid offices and social service providers about MassHealth terminations and the availability of MassHealth Renewal Extensions

Vicky Pulos, MLRI
It is not too late for renewing MassHealth members who receive termination notices to reapply and reinstate their coverage back to the date it ended, and you can help What happened? Almost 300,000 MassHealth renewal notices were mailed in January and February giving 500,000 MassHealth members…

Veteran's Healthcare Benefits Handbook

Military Handbooks
From the introduction: "This unique handbook, written for veterans, gives you everything you need to know about: how to apply, veterans service centers, choosing a facility, changing a facility, second opinions, prescriptions, dental care, chiropractic care, non-VA care, travel, POW…

Enrollment Dashboard for 2015 Open Enrollment

Connector and Office of Medicaid
2015 Open Enrollment started on Nov. 15, 2014 and ended on Feb. 23, 2015. It was the time in which people could freely purchase non-group health insurance on their own and also coincided with a new eligibility and enrollment system for MassHealth & the Connector going live and with various forms…

Sample MassHealth Renewal-Related Notices

Office of Medicaid
In 2015, the Office of Medicaid began renewing MassHealth eligibility for 1.2 million members under age 65 who are subject to the new MAGI methodology and have not had their eligibility renewed since October 2013. The first wave of 500,000 members have already been notified to submit a new…

MassHealth Renewals Process for 2015

Office of Medicaid
In this set of powerpoint slides posted on the MassHealth Training Forum website, MassHealth lays out its process for renewing eligibility for 1.2 million current MassHealth members starting in Feb. 2015.

MassHealt-Connector Cover Sheet -revised Feb 2015

Office of Medicaid
The following link is for a revised cover sheet to be used when faxing or mailing information to MassHealth or the Connector. A separate cover sheet should be printed out for each use (not photocopied) to assure that the bar code works properly.  Using these cover sheets should improve the…

Same-Sex Spousal Health Benefits

GLAD & Health Law Advocates
This document attempts to address some of the questions that may arise with regard to same-sex spousal health coverage. Click the "Go to Website" link below to download the guide from GLAD's website.  

E-fax Numbers for MassHealth Updated Jan. 2015

MassHealth
MassHealth is using a new fax number for submitting applications and verifications (except for Long Term Care).  Attached is MassHealth's Tip Sheet on Where to Send Applications and Verifications  

Massachusetts Bulletin for People with Medicare

Executive Office of Elder Affairs
Helpful information for Massachustts Medicare recipients regarding Medicare coverage, Medigap and Medicare Advantage Plans, and help paying for Medicare premiums and cost sharing.

Navigator List (2014-2015)

Connector Authority
Attached is the list of organizations that received Navigator grants from the Connector for the 2015 enrollment season. Navigators are trained to assist consumers to apply for MassHealth or insurance through the Connector and enroll in a plan. This list also describes the languages spoken by…

An Open Enrollment Primer for Non-Health Lawyers in Massachusetts

Vicky Pulos
This document is written for non-specialists about the current effort to reach 400,000 low and moderate income people who currently have health coverage under programs that end in early 2015. It provides background on the current situation, describes the affected clients, and offers some practical…

Tips for Meeting a Deductible for MassHealth Disabled Individuals Under Age 65

Nancy Lorenz, GBLS
Fact sheet for calculating one-time deductible or spenddown for CommonHealth disabled people who are not working 40 hours or more a month.

FY 2015 Budget for MassHealth & Health Reform Programs

MMPI, MassBudget and MLRI
This budget brief summarizes MassHealth and health reform spending in the 2015 budget. 

Frequently Asked Questions on Medicare and the Marketplace

CMS
In this set of Frequently Asked Questions CMS addresses the interaction between Medicare and new low cost insurance available for purchase through state or federal Marketplaces (also known as Exchanges). In Massachusetts we have a state based Marketplace/Exchange called the Health Insurance…

Confidentiality Toolkit - sharing data between government agencies

Administration for Children and Families (ACF)
From the preface: "We’re very pleased to be issuing the Administration for Children and Families (ACF) Confidentiality Toolkit, a product of ACF’s Interoperability Initiative.  For decades, human services agencies have been seeking to identify ways to promote…