Health Reform

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Understanding the ACA: the minimum income standard for ConnectorCare and how it affects seniors

Vicky Pulos
MLRI has updated its 2016 paper  on a quirky aspect of the law that is affecting a relatively small group of  seniors who may lose eligibility for ConnectorCare (which has no asset test) when their income drops below 100% of poverty or they go from being Lawfully Present to Qualified…

Advocate's Guide to MAGI

National Health Law Program
From the Executive Summary: "National Health Law Program's updated Advocate's Guide to MAGIaddresses changes to MAGI under the Republican tax plan enacted in 2017, as well as recently passed legislation affecting Modified Adjusted Gross Income-based calculations,…

Massachusetts Family Law & the ACA

MLRI
What Massachusetts Family Law Practitioners Should Know about the ACA Family law cases routinely involve decisions regarding custody, health care coverage, tax dependency exemptions, whether to file joint tax returns and what tax filing status might be most beneficial to the…

MLRI Letter to HWM on H2 proposal to drop 140,000 from MassHealth

Vicky Pulos
In January, 2018 the Governor's budget bill (H2) once again proposed dropping 140,000 nondisabled adults with income over 100% FPL but under 138% FPL from MassHealth leaving them with only potential ConnectorCare coverage. This letter to the Chair of the House Ways and Means Committee describes…

Update on MA legislation: Senate HEALTH bill

MLRI
On Nov. 7, the State Senate passed a broad-ranging health bill, a House bill is expected in early 2018.  

MassHealth Managed Care Notices Mailed Nov 13-Dec 22 2017

MassHealth & MLRI
Starting on Nov 13, and continuing through Dec 22, 2017 MassHealth is notifying 1.2 million members enrolled in managed care of new options starting March 1, 2018 including new Accountable Care Organizations. This is the Delivery System Reform Innovation approved in the November 2016 amendment to…

2018 Open Enrollment in Massachusetts

Vicky Pulos, MLRI
Attached is a flyer with basic information about  open enrollment for 2018.  This applies to people who are enrolled in or applying for ConnectorCare or other non-group health insurance. The flyer includes links to key information on the Health Connector website and elsewhere. Also…

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…

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…

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…

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).

The Governor’s FY2017 Budget Proposal for MassHealth (Medicaid) and Health Reform Programs

Mass. Medicaid Policy Institute (MMPI)
The Governor’s FY2017 Budget Proposal for MassHealth (Medicaid) and Health Reform Programs The Massachusetts Medicaid Policy Institute (MMPI), a program of the Blue Cross Blue Shield of Massachusetts Foundation, is pleased to share a new budget brief, The Governor’s FY2017 Budget Proposal…

Connector information in Spanish & other languages

Connector
The on-line application is currently only available in English but if you select a language in the upper right hand corner of the screen much of the information on mahealthconnector.org has been translated into other languages . Paper applications are available in English or Spanish.…

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…

New FPL Guidelines for Open Enrollment 2015-16

MLRI
Attached are the updated Federal Poverty Standards for the Connector Programs (Connector Care and Qualified Health Plans) for the Open Enrollment period beginning November 1st .  The actual effective date for eligibility purposes is January 1st, but enrollment for January starts in…

"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.  

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…

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…

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…

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…

Getting MAGI Right: A Primer on Differences that Apply to Medicaid and CHIP

Tricia Brooks, Georgetown Health Policy Institute
Another helpful resource explaining the MAGI income methodology now being used in Massachusetts for most people under 65 in MassHealth and for people seeking subsidized insurance through the Connector

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…

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…

Behavioral Health Services for People in MassHealth Fee for Service

Vicky Pulos, MLRI
This memo summarizes how people enrolled in MassHealth Fee for Service rather than Managed Care can gain access to behavioral health services.  It describes some of the differences between Fee for Service and Managed Care and offers some advocacy tips for children and adults having difficulties…

The Health Care Assister's Guide to Tax Rules

Center on Budget and Policy Priorities
Another great resource from the Center on Budget in D.C. to help advocates understand the new Modified Adjusted Gross Income (MAGI) methodology that will be used to determine eligibility for Medicaid for most adults under age 65 & eligibility for premium tax credits & other assistance…

Comparison of FY 15 House & Senate Budgets for Health Programs

MMPI, MassBudget & MLRI
Comparison of the House & Senate budget proposals for MassHealth & Health Reform program in the FY 15 budget. 

Student Health Insurance and Subsidized Plans

Mass. Health Connector
Memo from the Health Connector reminding colleges and universities that under the Jan 2014 Student Health Insurance rules, the following programs are comparable coverage and eligible for a waiver of the school's student health insurance plan: Commonwealth Care, ConnectorCare, MassHealth (except…

MassHealth-Connector Telephone Numbers & Other Resources

Office of Medicaid
The 'Support Information' tool is designed to help Navigators and Certified Application Counselors quickly find: 1.     The most direct customer service telephone number for your need; 2.     Where to Fax, Mail or Walk-in important…

Understanding the ACA: 2014 MassHealth Eligibility Changes for Children & Young Adults

Vicky Pulos
Short summary of 2014 changes affecting the eligibility of children and young adults for MassHealth with citations to the state regulations.

National Health Reform and You

Massachusetts Health Connector

Understanding the Affordable Care Act: How MassHealth Counts Income After Jan. 1, 2014

Vicky Pulos
This updated paper from MLRI describes changes in the methodology for determining income that were enacted as part of national health reform and how they will be implemented in MassHealth starting Jan. 1, 2014. The new tax-based methodology will affect most people on MassHealth except…

MassHealth Income Guidelines Effective March 1, 2014

Vicky Pulos and Neil Cronin, MLRI
Attached are the new income guidelines for MassHealth effective March 1st.   There are two charts.  The first from MLRI includes a couple of new features.  First of all, the 100% poverty guidelines used for MassHealth Elders includes the $20 income disregard in its base.  The…

CarePlus -Provider Bulletin

Office of Medicaid
In this March 2014 Provider Bulletin, the Office of Medicaid summarizes the new coverage type for adults 21-64 with income under 138% FPL availalbe as of Jan. 2014

Commonwealth Care extended to June 30, 2014 UPDATE 12-31-14

Vicky Pulos
The Commonwealth Care program was slated to end Dec. 31, 2013 with its enrollees transitioning into new coverage on Jan. 1, 2014. However, the transition did not go as planned. Commonwealth Care has been extended into June 2014. This document summarizes the situation as of February 2014. UPDATE:…

January 21 Eligibility and Enrollment Update

MLRI
Tomorrow the Governor releases his proposed budget for the next fiscal year.  Meanwhile, the health coverage landscape gets ever more confusing. Attached and reprinted below is our best effort to describe the Jan 1 transition with links to information from MassHealth & the…

New MassHealth Regulations, Jan. 1, 2014

Office of Medicaid
Effective January 1, 2014, an extensive set of regulatory changes took effect in MassHealth related to implementation of the Affordable Care Act including the repeal of MassHealth Basic, Essential and the Insurance Partnership and creation of a new program called CarePlus along with many other…

Student Health Insurance and Health Care Reform

Health Insurance Connector Authority
Fact sheet prepared by the Connector describing health insurance options for post-secondary students under health reform.

Guidance regarding amendments to Student Health Insurance Program

Mass. Health Connector
Guidance in Q & A format on Jan. 2014 rule changes affecting the Student Health Insurance Program including the required scope of benefits, when colleges & universities must waive the requirement for students to obtain the student health plan for students with comparable coverage, and…

Beyond the Basics -CBPP health reform website

The helpful website developed by the Center on Budget & Policy Priorities is devoted to Affordable Care Act implementation issues. It includes powerpoints from past CBPP webinars on topics such as MAGI and Premium Tax Credits, frequently asked questions and other resources. It addresses a…

MAGI Adjusted MassHealth Income Charts for January and February, 2014

Vicky and Neil
Income Chart good through February 28, 2014, showing MAGI income amounts effective January 1st, 2014.