MassHealth terminating Pt B premium assistance for 8900 on CommonHealth

During the post-pandemic redeterminations that MassHealth undertook between April 1, 2023 and March 31, 2024, MassHealth identified 8900 CommonHealth members  with income over 135% FPL for whom it was paying Medicare Part B premiums based on protections in place during the pandemic. Under the 1115 demonstration, CMS has only authorized MassHealth to pay Part B premiums for CommonHealth members with income under 135% FPL, and, according to MassHealth, it is required to terminate the Part B benefits for CommonHealth members with income over that level. A copy of an Update MassHealth distributed to SHINE counselors is attached.

In July, 2024 MassHealth sent the 8900 affected members a warning letter that they would be getting an appealable notice terminating their Part B benefits. The termination notices were scheduled to got out in 3 groups with notices going out in Aug-Oct and terminating payments in the following month Sept-Nov. The warning notice explained that members could elect to drop CommonHealth and switch to a Medicare Saving Program benefit, if eligible; do nothing and retain CommonHealth but lose payment of the Part B premium; or apply for MassHealth Standard plus MSP based on  clinical and financial eligibility for a HCBS waiver like the frail elder waiver, or PACE. It also advised that for those receiving Social Security insurance-based benefits, SSA would reduce future benefits by the amount of the Part B premium no longer paid by MassHealth. A copy of the July warning letter is attached. 

On Aug 1 MassHealth supplied us with this schedule of expecting closing reason mailing dates: 

 In mid-August, MassHealth sent the first batch of termination notices. However, the August mailing mistakenly omitted the fair hearing request form and instructions about how to appeal, and it stated that MassHealth would stop payments in August rather than September. Because of these errors, MassHealth informed advocates that people who received the first mailing will not have their Part B payments stopped in August/September. MassHealth will send out a corrected notice to them as well as the second group in mid September. A copy of the defective August termination notice is attached.

ADVOCACY NOTE: There are several potential grounds for CommonHealth members to appeal the termination of their Part B payments.  The three Medicare Advocacy projects that cover Massachusetts are an appropriate referral for individuals who have received termination notices and are interested in an appeal.

For aid pending appeal, the Board of Hearings must receive the request for fair hearing before the date of the action or within 10 days of receipt of the termination notice whichever is later. 

October 2024 Update 

Two  problems have recently arisen with the September termination notices that have not yet been resolved as of 10.11.24:

1.The notices lack a notice number. If a member appeals by phone, MH locates the notice by the notice number. At least two phone appeals were dismissed by the BOH because it could not locate the notice. Dismissals are subject to reinstatement when the member supplies a copy of the notice. Advocates have written to the BOH Director objecting to this practice as unlawful. 

2.BOH is not granting aid pending appeal to individual's who appealed from the Sept notices ending payment of Pt B premiums before the date of the change. According to the appellants' attorneys, BOH stated over the phone that it did not consider the notice to be a termination or reduction of current benefits giving rise to aid pending appeal. Two  redacted copy of the  Sept termination notices is attached: one is for a CH member under 65 and one for a CH member 65 or over. One of the attorneys has written to the BOH director & MH general counsel about what appears to be a clear error. 

If you are representing clients in these appeals, please stay in touch with one of the three MAP programs or MLRI for recent developments..