Eligibility

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MassHealth & Health Connector Unwinding Policy Updates (April 2024)

MassHealth & Health Connector
Attached is the  MassHealth & Health Connector Learning Series Update for the Spring 2024 Massachusetts Health Training Forum (MTF). In the MassHealth section it includes information about the status of various policies in place during the unwinding. Some are ending in 2024 in April, June…

Understanding immigrants' eligibility for MassHealth & other subsidized coverage, March 2024

Vicky Pulos, MLRI
This  updated March 2024 memo summarizes the current immigrant eligibility rules that MassHealth and the Health Connector use in making decisions about what kinds of coverage non-citizens with different kinds of status can receive. The update reflects federal law changes in 2021…

2024 Upper Income Limits for MassHealth and other Coverage Programs

MLRI
Attached is MLRI's March 1, 2024 Table upper income limits in MassHealth, MSP, Health Safety Net, CMSP and ConnectorCare, along with the Nov 1 2024 Table showing the undated income limits for ConnectorCare coverage in 2025; open enrollment for 2025 begins on Nov 1, 2024. MassHealth's Desk Guide…

Lawsuits challenging Medicaid Redeterminations in FL and NC

NHelp with Florida Health Justice and with Charlotte Legal Advocacy
With the nationwide end of the pandemic-related continuous coverage/maintenance of effort policy that was in effect from March 17, 2020 until Mar 31, 2023, there has been a nationwide spotlight on administrative barriers that result in eligible Medicaid members losing coverage at…

MassHealth Fair Hearing Decisions

Office of Medicaid Board of Hearings
MassHealth has started posting fair hearing decisions on its website. As of February 2024, there are over 2400 decisions from July -Sept 2023 currently posted with a filtering feature by topic. 

Advocacy Tips for Helping Older Adults Retain MassHealth

Victoria Pulos
Attached is a  powerpoint presentation with citations to authority describing pathways to MassHealth coverage for older adults in the community whose countable income  exceeds 100% FPL and/or whose countable assets exceed $2000/$3000. It is intended to assist legal aid lawyers and…

HIX System Changes in Dec 2023

MassHealth & the Health Connector
Attached is an Assister Update  describing a series of December 2023 changes to the HIX system that determines eligibility for MassHealth for most people under 65 and for ConnectorCare and premium tax credits from the Health Connector. The update describes new questions and messages in the…

CommonHealth, State-Funded Standard and 12-month Post-Partum EOM updates

MLRI
This paper flags  Eligibility Operations Memos issued in 2022 and 2023 where MassHealth has issued an update, revision or correction and explains what changed. The updated EOMs all described expanded coverage in CommonHealth, State-funded Standard for certain non-citizens, and 12-months…

MassHealth Webinar on Understanding Citizenship & Immigration Requirements for Health Programs

MassHealth & Health Connector
Attached are slides of this Jan 2024 webinar in the Massachusetts Health Training Form (MTF) Learnings Series developed by MassHealth and the Health Connector called Understanding  Citizenship and Immigration Requirements for Health Programs.  A YouTube recording of the webinar is…

30A Complaint in MSP Appeal

MLRI
Attached is a complaint for judicial review and declaratory judgment in an appeal from an adverse decision by the Board of Hearings. The case involved the failure of MassHealth to implement the Jan 1, 2023 expansion of the income eligibility criteria for Medical Savings Programs for people who…

How Money Damages and Settlements Impact Selected Public Benefits

MLRI
The following chart provides an overview of the income and asset limits for common public benefits, healthcare, and housing assistance programs, and highlight rules regarding the treatment of lump sums from money damages payments and settlements. The chart is primarily intended for use by legal…

New MassHealth Unit for Problem Cases

MassHealth
New Escalation Protocol for Problem MassHealth Cases: The Service Solution Unit (SSU) MassHealth is standing up a new process to “escalate” problem MassHealth cases after initial attempts to resolve an issue with MassHealth Customer Service or the MassHealth Enrollment Center or other units…

MassHealth after incarceration

Isabel Wanner
Attached is a flyer prepared by MLRI's Health Justice Advocate Isabel Wanner explaining what to do if someone is at risk of losing MassHealth or Health Connector benefits based on incorrect or out of date information that they are incarcerated. The Flyer is in English & Spanish Also attached…

Comments on Proposed MassHealth 1115 Amendments

MLRI, CHLPI, HCFA
In August 2023 MassHealth proposed 8 amendments to the current 1115 demonstration, with an opportunity to comment by Sept 9, 2023 including proposals to:  Provide 12-months continuous eligibility for all adults (continuous eligibility for children is already required as of Jan 1,…

MassHealth Monitoring Project

MLRI
The mission of MLRI’s MassHealth Monitoring Project is to ensure that everyone on MassHealth keeps their coverage, or moves to other affordable coverage, during the April 1, 2023 to March 31, 2024 MassHealth eligibility redetermination process. This website - which includes…

What's in the Blue Envelope for People Turning 65

MassHealth
MassHealth is in the process of renewing eligibility for all its 2.4 million members during the one year period from April 1, 2023 to March 31, 2024. If eligibility can't be renewed through data matching, beneficiaries will be sent a blue envelope with a notice dated April 1, 2023 or later to be…

MassHealth Renewal: What's in the blue envelope for people under 65?

MasHealth
MassHealth is in the process of renewing eligibility for all its 2.4 million members during the one year period from April 1, 2023 to March 31, 2024. If eligibility can't be renewed through data matching, beneficiaries will be sent a blue envelope with a notice dated April 1, 2023 or later to be…

MassHealth Reinstated People Wrongly Terminated based on "Change in Household" Prior to March 31, 2023

MassHealth & MLRI
Over the last six months, advocates have brought cases to light of people losing MassHealth despite the continuous coverage protection  based on reported changes that were treated by the computer system as voluntary withdrawals when that was not what the member intended. A voluntary withdrawal…

A bill to reinstate 3 months retroactive MassHalth Coverage in 2023

MHA & MLRI
Attached is a fact sheet on a bill filed in the 2023 session to restore retroactive MassHealth coverage; MassHealth plans to end this coverage for new applicants 19-64 who are not pregnant when the COVID-19 Public Health Emergency ends expected to be this spring.

Updated Office of Medicaid Guidance on Cuban-Haitian Entrants

Office of Medicaid
This Feb 2022 Eligibility Operations Memo from the Office of Medicaid provides information on how to identify Cuban-Haitian entrants who are "qualifed aliens" eligible for medical benefits on the same terms as US citizens. It updates an earlier June 2020 El Ops Memo to include examples of…

Update on Haitian Entrants

Misc
Feb 2022 UPDATED MassHealth Guidance on Cuban-Haitian Entrants https://www.mass.gov/doc/eom-22-03-eligibility-rules-for-cuban-and-haitian-entrants-0/download  Background Information on Newly Arriving Haitians Recently, hundreds of Haitian families, many with children, have arrived in…

MassHealth Protection Notices During COVID-19

Office of Medicaid
This is a copy of the "protection notice" that MassHealth is sending out to certain beneficiaries who had been sent a renewal form, request for information or reported a change. It notifies them that they are still enrolled in their current coverage, not because they are eligible for it,…

March & Nov 2021 Update of FPL Tables in MassHealth & Health Connector

MassHealth & MLRI
Attached are updated Tables from MassHealth and MLRI showing the upper income levels for MassHealth and Health Connector programs. It is updated to show the cost of living adjustments for 2021 that take effect in MassHealth programs on March 1, 2021. The Health Connector uses the 2020 federal…

Health Benefits for Newly Arriving Afghans

MLRI
Massachusetts will soon be home to several thousand newly arriving Afghans. Most should be eligible for health coverage in MassHealth Standard or CarePlus. We have created this google doc to keep you abreast of the latest information we have to help new arrivals receive the correct…

IRS Stimulus Payments Never Treated as Assets

Office of Medicaid
This announcement from MassHealth clarifies that IRS Stimulus payments (also called Economic Incentive Payments or Recovery Rebates) are not income in the month of receipt and unspent funds will not be treated as countable assets for 12 months from receipt and for the duration of the federal public…

MassHealth's May 2021 Changes to its COVID Continuous Coverage Protections

MLRI
Attached is a memo written by MLRI explaining MassHealth's guidance issued on May 4, 2021 describing certain changes in the continuous coverage protections in place during the federal public health emergency including advocacy that may be needed to protect some people from losing access to…

MAGI Resources

Various
Since 2014, MAGI or Modified Adjusted Gross Income has been the  income methodology used by MassHealth for most people under age 65, and also used by the Connector to determine eligibility for ConnectorCare and Premium Tax Credits. Attached is a set of FAQs about MAGI from the Center on…

Applying for Health Coverage: How does unemployment income count?

Vicky Pulos
This guide describes where to enter unemployment income on the combined application form used to apply for both MassHealth and help paying for private insurance from the Health Connector. It includes pictures of what some of  the key screens of the online health application look like…

How MassHealth & the Health Connector Treat New Payments under the CARES ACT

MLRI
This MLRI Table shows how MassHealth and the Health Connector count new payments authorized by the Coronavirus Aid, Relief, and Economic Security (CARES) Act: a one-time tax rebate from the IRS in the amount of $1200 per eligible adult and $500 per qualifying child under 17, extended Unemployment…

MassHealth Continuous Coverage during COVID 19 Emergency

MLRI
On March 18, the Families First Coronavirus Response Act was enacted. It prohibited states from ending coverage for Medicaid beneficiaries enrolled on March 18, 2020 or later and continuing until the end of the COVID-19 emergency. CMS has issued two sets of FAQs for the states with more…

MassHealth Coverage Protected During COVID-19 Emergency

EOHHS
Important News from MassHealth: Moratorium on Eligibility Terminations During Emergency:  MassHealth announced important new protections for MassHealth members who were enrolled in MassHealth benefits on March 18, 2020 or later. Many thanks to everyone at the Office of Medicaid for their…

2020 Upper Income Levels for MassHealth & Other Health Programs

MLRI and EOHHS
Attached are updated income tables for 2020 showing the upper income limits in MassHealth and Other Health programs. One table is the MassHealth Desk Guide showing the annual and monthly amounts that correspond to different percentages of the federal poverty level used by MassHealth; the 5%…

MassHealth & Temporary Census Earnings

Vicky Pulos
Temporary census work is currently available but MassHealth members may have concerns that the added income will jeopardize their continued eligibility for MassHealth.  This Q & A for providers & advocates describes how MassHealth treats temporary census earnings for individuals…

A New Opportunity for Seniors and People with Disabilities Enrolled in MassHealth Home & Community Based Waivers & PACE To Maintain Eligibility After an Increase in Income

MLRI
Memo on a new policy on "post-eligibility treatment of income" for people already enrolled in a HCBS who experience an increase in income. Update: October 1, 2019 MassHealth Eligibility Operations Memo, Post-Eligibility Treatment of Income (PETI) for Home- and Community-Based…

PS 16-2: Request for Access to Personal Health Care Information (PHI): DES Authorization to Release Information

DES
Note that as of July 8, 2019, DES has a new Authorization to Release Information form, https://www.masslegalservices.org/content/des-authorization-release-information.  Prior version, July 21, 2016.

August 2019 State Health Update:

vicky pulos
Attached is an update of several health items in the FY 20 state budget, improvements in the state medical child support law,  improvements in the MassHealth/Connector online system, and several positive changes in MassHealth eligibility policies. 

MassHealth Benefit Request Applications (English and Spanish)

EOHHS
Application for Health and Dental Coverage and Help Paying Costs [English] Instrucciones para solicitud de cobertura de salud y dental de Massachusetts y ayuda para pagar los costos [Spanish]

2019 Upper Income Levels for MassHealth & Other Health Programs

MLRI and EOHHS
Attached are updated income tables for 2019 showing the upper income limits in MassHealth and Other Health programs. One Table is the MassHealth Desk Guide showing the annual and monthly amounts that correspond to different percentages of the federal poverty level used by MassHealth; the 5% of FPL…

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,…

2018 Spousal Impoverishment Standards

CMS
Updated standard for calculations when one spouse is in nursing home applying for MassHealth and one spouse is at home. 

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…

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…

Inaccessible resources ALJ decision & memo

Rachel Brown, CLA & ALJ
Attached is a legal memo by Rachel Brown at CLA and the resulting favorable ALJ decision in a 2017 SSI case finding that the applicant's half interest in a house co-owned with an abusive partner and located outside of Massachusetts where the abuser still lived was not an accessible resource because…

"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…

2015 MassHealth Income Standards

Office of Medicaid
MassHealth updated its income standards to reflect updated 2015 federal poverty levels on March 1. MLRI is currently working on our version of the 2015 income standards which we will be posting soon. 

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…

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.

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…