Masshealth/ Medicaid

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MassHealth is the name given to the Massachusetts Medicaid Program. This section contains information concerning eligibility and services under the MassHealth program, as well as links to important web sites needed for effective advocacy for MassHealth applicants and recipients. The section also contain copies of fair hearing decisions involving the MassHealth program, but we need your help:

Please send us copies of your fair hearing decisions to the attention of Vicky Pulos, MLRI, 40 Court Street, Suite 800, Boston, MA 02108,  vpulos@mlri.org.

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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. 

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…

EPSDT-A Guide for States: Coverage in the Medicaid Benefit for Children & Adolescents

Centers for Medicare and Medicaid Services
The Centers for Medicare & Medicaid Services (CMS) has just published a Guide to the Early Periodic Screening, Diagnosis and Treatment benefits for children and youth under age 21 in Medicaid. The 38 page EPSDT Guide was written in collaboration with the National Health Law…

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…

An Advocates' Guide to Oversight of Online Benefit Applications

Coalition for Access and Opportunity
Materials from a webinar on this topic.  Presenters included the Center on Budget and Policy Priorities, Center for Law and Social Policy and Florida Legal Services. Materials inlcude an Online Application Review Guide, a tool to assist advocates in reviewing a state's online application…

Just Like Home: An Advocates Guide to Consumer Rights in Medicaid HCBS

Justice in Aging
From the introduction to the Guide: "The National Senior Citizens Law Center (NSCLC) [now called Justice in Aging] believes that home and community-based services (HCBS) should be provided as an option to every Medicaid beneficiary (consumer) who needs such services, allowing more…

My Ombudsman Website

Disability Policy Consortium
The Disability Policy Consortium has a contract with MassHealth to operate an Ombudsman program to assist MassHealth members having problems with their managed care plans. It was originally created to help people in One Care, an integrated managed care program for individuals with…

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…

MassHealth: The Basics

Massachusetts Medicaid Policy Institute (MMPI)
The Massachusetts Medicaid Policy Institute released an updated version of its guide, MassHealth: The Basics, prepared by the UMass Medical Center for Health Law and Economics.  In addition to an overview of MassHealth program and enrollment trends, this version includes a charts and…

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

MassHealth CarePlus Fact Sheet

Office of Medicaid
On January 1, 2014 a new type of MassHealth coverage became available called MassHealth CarePlus for adults age 21 to 65 with income at or below 133% of the poverty level and who are not eligible for Medicare. It is part of the expansion of the Medicaid program under federal health reform.…

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…

CarePlus: Sample Eligibility Notice

Office of Medicaid
A sample of the kind of notice sent to adults 21-64 with income under 138% FPL who have been determined eligible for CarePlus including notice of how to request a change to Standard based on special medical needs (being "medically frail")

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…

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.

Temporary MassHealth -Provider Bulletin

Office of Medicaid
Applicants for subsidized coverage to start on  Jan. 1, 2014 or later from MassHealth or the Connector for whom the broken computer system has been unable to make anl eligibility determination have instead been enrolled in MassHealth Standard Fee for Service coverage on a temporary basis until…

Re-Forming Reform Pt. 2: Implementing the Affordable Care Act in Mass.

Elizabeth Rodman, BCBS Foundation
Good summary of the changes in subsidized coverage scheduled to take effect on Jan. 1, 2014 & other reforms in the private insurance market in Massachusetts.  Readers should be aware that many of the changes described have been delayed due to the failure of the new HIX-IES eligibility…

MassHealth: Roadmap to 2014, Affordable Care Act Transition Plan (Draft)

EOHHS
Under the MassHealth 1115 demonstration, the state is required to file & periodically update a plan for transitioning from current coverage to expanded Medicaid eligibility and new forms of subsidized coverage effective in Jan. 2014. EOHHS released its first Transition Plan in July 2012. In June…

CarePlus-Table Comparing Benefits to Standard

Office of Medicaid
This Table from the June 2013 Roadmap to Coverage compares the benefits covered in MassHealth CarePlus with those covered in MassHealth Standard. Adults enrolled in CarePlus who need one or more services only available in Standard may be able to change their coverage to Standard if they have special…

MassHealth recognizes H1B & H4 status as AWSS/PRUCOL

MassHealth Training Unit
In its Weekly email update to the MassHealth Enrollment Centers, the MassHealth Training Unit confirms that specialty workers with an H1B visa status & their H4 dependants are considered Permanently Residing Under Color of Law/Lawfully Present for purposes of MassHealth &…

Ops Memo 2012-52: Social Security Administration (SSA) Expansion of SSNs and the Impact on NewMMIS

DTA
Overview On June 25, 2011, the Social Security Administration (SSA) expanded thenumber combinations used for the first three digits of Social Securitynumbers (SSNs). As a result of this expansion, all three-digit combinationsfrom 001 through 899, with the exception of 666, will be used when…

Best Practices for Effective Communication with Members and Applicants with Disabilities

Office of Medicaid
In this Eligibility Operations Memo, the Office of Medicaid describes a process for identifying individuals with disabilites and offering accommodation in communications. It also describes creation of a MassHealth Disability Acccommodation Ombudsman to address requests for accommodation.

MassHealth's Electronic Data Management (EDM) Project

Vicky Pulos, MLRI
This memo by MLRI describes MassHealth's new system for storing and retrieving eligibility documents electronically & offers some practical tips for using the new system & how it may help troubleshooting problems related to processing delays.

New Process for Handling Disability Supplements (EOM 11-06)

Office of Medicaid
New Process for Handling Disability Supplements is described in the attached  Eligibility Operations Memo

Just for Youth: Advocating for Youth in the Massachusetts Department of Youth Services

Mental Health Legal Advisors Committee
  The Mental Health Legal Advisors Committee's DYS Project has released the on-line version of the Third Edition of "Just for Youth: Advocating for Youth in the Massachusetts Department of Youth Services." This edition incorporates changes in DYS policy and practice,…

MassHealth Regulations and Other Publications

Updates About MassHealth Benefits -- December 2010

Masshealth
MassHealth sent this member notice out in December. It corrects information in an earlier May notice about the limitation in MassHealth payment for inpatient hospital days to 20 days. It makes clear that MassHealth-eligible patients hospitalized for longer than 20 days will NOT be liable for the…

CMS letter on "legally residing" pregnant women & children

Cindy Mann, CMS
Letter from CMS to the states describing new category of "legally residing" immigrant pregnant women & children who can be treated as fully eligible for Medicaid 

MLRI Analysis of CHIP Reauthorization

MLRI
On Feb 4, 2009 President Obama signed the Children's Health Insurance Reauthorization into law. MLRI analyzes some of the new options for states to improve coverage for children in Medicaid and CHIP under the new law.

MassHealth Breast & Cervical Cancer Program Flyer

MLRI
MLRI has prepared a flyer on the MassHealth Breast & Cervical Cancer program --more affordable and comprehensive benefits for uninsured women AND women on Commonwealth Care or MassHealth Essential

Eligibility Operations Memo on MBR Changes Involving Employer Sponsored Insurance

MassHealth Premium Hardship Waiver

Hardship Waiver for MassHealth Premiums

Thousands of MassHealth Households Subject to Termination for Non-Payment of Premiums

Starting in March, somewhere between 5,000 and 10,000 MassHealth households who are currently responsible for premiums will receive notices that they are in substantial arrears on their monthly MassHealth premiums, and that they will be put on a six month payment plan to pay off their arrearage. …

Letter to Sec. Bigby on poverty level reclassification

MLRI, HCFA
This letter from MLRI & HCFA urges Sec. Bigby to automatically reclassify MassHealth members under the new 2007 poverty level standards without waiting for annual redtermination. Advocates should also check for clients who may be entitled to a richer coverage type or lower premiums under the new…

Revised Office of Medicaid Form for Massachusetts birth certificate

The Office of Medicaid has revised the form to be used to request a record of Massachusetts birth from the Vital Statistics Office. The birth record will be sent back to the Office of Medicaid not the applicant. An applicant born in Mass. who needs a copy of the birth certificates can obtain it…

What advocates need to know about expanded coverage under the new health reform law

MLRI
This January 2007 memo outlines new coverage options for people under 300% of the poverty level under the 2006 health reform law including Commonwealth Care for uninsured adults and expanded Family Assistance for children.

MLRI Comments to CMS on Citizenship Verification with 15 Organizational Co-signers

MLRI
Fifteen Massachusetts organizations sign on to MLRI's comments to the Center for Medicaid/Medicare Services (CMS) on interim final regulations requring states to verify citenship and identity for citizens applying for Medicaid. cit

New Citizenship Verification Requirement for MassHealth

CMS fact sheet on requirement that US citizens verify citizenship

CMS
The federal Medicaid agency (CMS) has published interim final rules implementing the provision of the DRA requiring US citizens to verify citizenship & identity. Unlike earlier guidance, the rules exempt citizens who are SSI & Medicare recipients from having to prove citizenship. The…

Notice to Members of New & Restored Benefits

This is the notice MassHealth mailed to members telling them about the July 1 2006 benefit improvements; more detailed information for providers and emergency rules are now or will soon be posted at https://www.mass.gov/topics/masshealth

MassHealth Announcement of Verification Requirement for US Citizens

MassHealth
This is the announcement MassHealth has prepared describing how it will implement a new federal law requiring US citizens applying for Medicaid after July 1, 2006 to verify that they are citizens

MassHealth Changes on July 1, 2006

Changes in MassHealth effective July 1 include: restoration of optional benefits to adults; new smoking cessation benefit; increase in income eligibility for children & youth under age 19 to 300% of poverty, and implementation of federal rules requiring US citizens to verify citizenship &…

Comments to proposed Florida Medicaid reform

CPR is working with Florida's Advocacay Center for Persons with Disabilities to seek changes to portions of Florida's sweeping Medicaid waiver proposal. Our letter to the state may be of interst to MA Medicaid advocates as Florida's program is being considered as a model by other…