Can MassHealth Limited and HSN cover the gap for immigrant clients?

People who lost their Commonwealth Care coverage on September 1 because they are deemed Aliens With Special Status (AWSS) will be enrolled into a new CeltiCare plan over the next few months. In the meantime, they have access to either MassHealth Limited + the Health Safety Net, or the Health Safety Net (HSN) alone. Letters went out in August (PDF) telling people which benefit they would be eligible for until CeltiCare takes effect. Only those who recently lost their Commonwealth Care coverage will be allowed to join CeltiCare; others will continue to have access only to MassHealth Limited and/or HSN.

MassHealth Limited and/or HSN will be good enough for some people. But others may face serious health needs that cannot be met by these programs while they’re waiting to be enrolled in CeltiCare. In your judgment, if you see a client who needs urgent medical services not available through HSN and/or Limited, please call 1-877-MA ENROLL and ask for help. A special team has been assembled to look at a client’s needs and make sure Limited and HSN access is maximized; in some cases, this team may determine additional gap coverage through MassHealth is appropriate until enrollment in the new CeltiCare plan.

To help you determine whether a client’s need can be met by their Limited and/or HSN coverage, we’ve reviewed the programs here, and prepared a one-page reference sheet: Piecing it Together: MassHealth Limited + Health Safety Net (PDF).

Using MassHealth Limited coverage
MassHealth Limited covers emergency services only—treatment for medical conditions with symptoms so acute they would seriously jeopardize an individual’s health without immediate care. About 30% of AWSS-deemed people who were on Commonwealth Care now have MassHealth Limited. Some of the services covered by MassHealth Limited include:

• Outpatient visits and inpatient stays at acute care hospitals, related to an emergency condition or childbirth;
• Emergency dental care from a MassHealth dental provider;
• Emergency services related to ongoing health conditions (this can include insulin, dialysis, oxygen, or emergency cancer treatment);
• Transportation by ambulance; and
• Antibiotics and other medically necessary drugs prescribed in conjunction with emergency services (for a total of a 30-day supply).

Using the Health Safety Net
The Health Safety Net will pay for medically necessary services that are on the list of MassHealth Standard covered services, as long as the services are offered by and provided to you through a community health center or acute care hospital. (MassHealth Limited members can also use the Health Safety Net to access non-emergency services at those sites.) These resources may help:

• A searchable directory of community health centers—including which provide primary, dental, and eye care (please contact the health center to see what pharmacy options are available)
• A map of acute care hospitals in Massachusetts

For details and examples of what's covered by MassHealth Limited, see this excerpt from the MassHealth Advocacy Guide (PDF) prepared by Vicky Pulos of the Massachusetts Law Reform Institute—our primary source for the information we've put together. This All Provider Bulletin about MassHealth Limited (PDF) from MassHealth may also help.

How is this working for your clients' health needs?