MassHealth Updates

1. 1 MassHealth Updates Massachusetts Health Care Training Forum January 2011

2. 2 Today�s MassHealth Updates 1. The Member Education Unit 2. Children�s Health Insurance Program Reauthorization Act 3. Electronic Document Management Project 4. Change of Address for Taunton MEC LTC applications 5. Publication Update 6. Puerto Rican Birth Certificate Verification Process 7. MassHealth Reporting for the Health Care Reform Mandate Requirement 8. New Asset Limits Buy-In Programs

3. 3 The MassHealth Program & the Member Education Unit The MassHealth mission is to help the financially needy obtain high-quality healthcare that is affordable, promotes independence, and provides customer satisfaction. In conjunction with the MassHealth mission the Member Education Unit�s goal is to effectively educate our applicant/member�s regarding their potential for, and receipt of MassHealth benefits. The MassHealth Member Education unit provides presentations, information, program updates, operational and policy changes, and useful tools upon request, to all agencies and individuals who work with Massachusetts residents seeking MassHealth and or other health coverage.

4. 4 Childrens Health Insurance Program Reauthorization Act (CHIPRA) of 2009 CHIPRA was signed into law Feb 4, 2009. A provision in the law allows for expansion of coverage to certain MassHealth children and pregnant women who were formerly barred from federal coverage because of immigration status. On 8/29/09, we moved 5 year bar children and pregnant women to federal coverage MassHealth received guidance from CMS to grant benefits to also extend federal coverage to PRUCOLs (Permanently Residing Under Color of Law). On 11/22/10, MassHealth moved PRUCOL children and pregnant women to federal coverage. Impacted individuals received an upgrade notice and a reimbursement request form for health expenses that would have been covered by federal coverage since 8/29/09 (example: dental for pregnant women).

5. 5 Children�s Health Insurance Program Reauthorization Act (CHIPRA) of 2009 (continued) PRUCOL (Permanently Residing Under Color of Law) Children: Under 150% FPL who received state-funded Family Assistance or CommonHealth will be upgraded to federally-funded MH Standard. Between 150% and 200% FPL will remain in Family Assistance but the state will receive federal funding. Between 200% and 300% FPL who received CMSP will upgraded to federally-funded Family Assistance. PRUCOL (Permanently Residing Under Color of Law) Pregnant Women: With income less than or equal to 200% FPL who received Healthy Start (HSP) will be upgraded to MH Standard. PRUCOL applicants/members will be required to provide a SSN or verify that they have applied for one in order to receive MH Standard or Family Assistance.

6. 6 Electronic Document Management (EDM) Project Phase I EDM will image paper in enrollment and renewal processes and will significantly improve workflow. The EDM project has been launched at the Taunton MEC 1/06/11. MassHealth Operations is pursuing a phased-in statewide roll-out approach. Updates will be provided at future MTF sessions. Images to be accessed within 48 hours from received date. New fax machines and future e-faxing. One entry for all documentation. No faxing to individual worker or manger unless if an emergency.

7. 7 Electronic Document Management Project Phase I Send information with valid identifiers. Fax or mail but do not do both. Always fax or mail information to the address on the notice. If possible keep individual information separately. As a result of EDM, all LTC applications and related LTC intake verifications previously sent to Taunton MEC are now to be sent to a new mailing address for processing. See Provider Bulletin for LTC Intake.

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9. 9 MassHealth Publications Effective January 2011, MassHealth program revisions were made to the applications, member booklets, and the long term care supplement. Changes were made to clarify information regarding asset limits and asset transfers. Changes were made to gather additional information regarding income and unemployment. Some sections have been reformatted or moved into another part of the application. A new section �visitors� has been created to define and clarify visitor circumstances. Full details of all changes can be found in the Publications section at the MassHealth website www.mass.gov/masshealth Paper applications can be downloaded from the MassHealth website. Bulk supplies of applications can be ordered by phone, fax, or email.

10. 10 Puerto Rican Birth Certificate Verification Process New legislation enacted by the Commonwealth of Puerto Rico (PR) invalidated all birth certificates issued prior to July 1, 2010. On July 1, 2010 the Commonwealth of PR began to issue new birth certificates and they established a three-month transition period that extends the validity of birth certificates prior to July 1, 2010 through September 30, 2010. Puerto Rico has since issued an extension on the time previously issued birth certificates should be accepted based on delays in replacing the documents with newly-issued documents. �CMS has issued revised instructions to Medicaid programs to reflect this. � MassHealth is currently accepting all birth certificates from residents of Puerto Rico regardless of issuance date due to delays in replacing the old documents with the newly-issued documents. MassHealth will make changes if necessary due to updated CMS guidance regarding birth certificate documentation from Puerto Rican residents.

11. 11 MassHealth Reporting for the Health Care Reform (HCR) Mandate Requirement Massachusetts law requires adult residents who are 18 years or older to have health insurance if they can afford it. The law also requires insurance companies to send notification of covered months to their members. MassHealth, as a health insurance provider, will send the Schedule HC to MassHealth members for their 2010 Massachusetts income tax return.

12. 12 MassHealth Reporting for the Health Care Reform (HCR) Mandate Requirement MassHealth will issue the Form MA 1099-HC to members with income greater than 150% FPL at any point during the calendar year 2010 Who had MassHealth eligibility during the calendar year 2010 and who were at least 18 years old as of January 1, 2011. MassHealth addresses a partial month of coverage in the following manner: Coverage of 15 days or more in one calendar month is treated as a full month of coverage. Coverage of 14 days or less in one calendar month is treated as a month without coverage. By law 1099-HC must be issued by 1-31-2011.

13. 13 New Asset Limits for Buy-In Programs The Buy-In programs pay the part B Medicare premium for individuals or couple and the QMB Buy-In program will pay for Medicare co payments and deductibles and the part B premium. Due to a provision in the Medicare Improvements for Patients and Providers Act (MIPPA), asset limits have increased for all of the Buy-In programs effective January 1, 2011. The provision adjusts the buy-in asset amount to match the asset test for low-income individuals who complete the Part D Low-Income Subsidy Application at Social Security.

14. 14 New Asset Limits for Buy-In Programs (Continued) The limit for an individual has been raised to $6680 formerly ($6600). The limit for a couple has been raised to $10,020 formerly ($9910). MassHealth regulations 130 CMR 519.000 and 519.001 are being revised with the updated figures. See the Eligibility Operations Memo posted at the MassHealth website www.mass.gov/masshealth for further details.

15. 15 Income Guidelines for Buy-In Programs

16. 16 Application Process for Buy-In Programs Individuals can apply for the Buy-In programs on paper applications or through the Virtual Gateway. An individual or couple can do a shortened application if they only want to apply for the Buy-In. The shortened applications are available on the MassHealth website and can only be completed on paper. They are not available to do through the Virtual Gateway. The condensed Buy-In application is processed at the Tewksbury MassHealth Enrollment Center.

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