Updates from MassHealth: MassHealth Family Assistance Coverage Expansion Update

10/19/21
More about LTSS expansion for immigrants in Family Assistance
 
We are still waiting for release of the Eligibility Operations Memos that should provide more information about how this will actually work--but forwarded here is the first written communication from MassHealth about the Nov 1, 2021 expansion of Long Term Services and Supports (including PCAs and  nursing home care) for Lawfully Present or PRUCOL immigrants who don't yet qualify for federally reimbursed Medicaid but do qualify for state-funded Family Assistance.  WBUR covered the story last Friday with quotes from an affected family, and MHA  and a particularly good quote from our colleague Andrew Cohen at HLA
 
 
 
 


 

---------- Forwarded message ---------
From: MAhealthconnectorUpdates <mahealthconnectortraining@state.ma.us>
Date: Mon, Oct 18, 2021 at 5:31 PM
Subject: Updates from MassHealth: MassHealth Family Assistance Coverage Expansion Update
To: <vpulos@mlri.org>
 
 
 
 
Assister Updates
Important News for Certified Assisters In Massachusetts 
 
October 18, 2021
 
In this edition:
 
  • MassHealth Family Assistance Coverage Expansion Update
  • How to Request My Ombudsman Materials
 
MassHealth Family Assistance Coverage Expansion Update
 
In response to challenges when discharging patients to appropriate settings, MassHealth implemented a permanent expansion of MassHealth Family Assistance coverage for chronic disease and rehabilitation hospital (CDRH) services and nursing facility services in July of 2020.
 
To ensure continued equitable access to health coverage regardless of a members’ immigration status, effective November 1, 2021, MassHealth will expand coverage of skilled nursing facility stays and community-based services for individuals on Family Assistance when the member meets a Nursing Facility Level of Care.
 
Expanding covered services to MassHealth Family Assistance members removes barriers and challenges that members encountered when trying to access services.
 
Family Assistance Coverage Expansion
 
Effective November 1, 2021, Family Assistance coverage expansion will include:
 
  • The expansion of short-term stay coverage from 100 days to six months
  • For members who need care beyond six months in a facility or community-based long term care services and support facility, coverage includes a new option to enroll in (state-funded) MassHealth “Standard” or “CommonHealth”
 
How Family Assistance Members Can Access Benefits
 
To access these benefits, MassHealth members or their Authorized Representatives, including health care facilities, must notify MassHealth of a change in health care needs. This includes reporting disability status or need for long-term care in a facility. The notification starts the application process.
 
Individuals applying for the first time must submit, depending on their circumstances, either the
 
  • Application for Health and Dental Coverage and Help Paying Costs or 
  • Application for Health Coverage for Seniors and People Needing Long-Term-Care Services. For more information about how to apply, go to Information for MassHealth Applicants | Mass.gov.
 
Normal financial eligibility rules for MassHealth Standard and MassHealth CommonHealth long term care coverage, in a nursing facility or CDRH, or for those receiving LTSS services in the community apply.
 
How to Request My Ombudsman Materials
 
My Ombudsman is a program for MassHealth health plan members who have questions or need help getting services from their health plan. The program can:
 
  • Give members information about their health plan benefits and rights, 
  • Answer questions, listen to member concerns and help address problems, and
  • explain how to file a grievance or appeal and what to expect during the process.
 
To request My Ombudsman materials for your locations, such as magnets and brochures (available in both English and Spanish), e-mail info@myombudsman.org with the subject line “My Ombudsman materials request.”
 
For more information about My Ombudsman:
 
 
MassHealth