Recently, I have seen an increase in the number of Exceptions Forms sent to Commonwealth Care applicants who the state believes have access to employer-sponsored insurance. These clients are not eligible for Commonwealth Care until they return the Form – but it can be hard to understand what makes the state mail it to these individuals in the first place. These are a few examples of cases I’ve seen, as an Outreach Worker at Manet Community Health Center in Quincy and Hull:
CASE #1
On April 3, 2008, I received in the mail an Exceptions Form for a man who worked part-time as a long-haul delivery driver but mostly did odd-jobs and got paid in cash. He did not file taxes, and his income was self-reported as $500 weekly, working 80 hours per week. He considered himself a day (and night!) laborer. On his Virtual Gateway application, which I completed, I indicated that he was not offered insurance and had not been offered insurance within the past six months.
I called the Taunton MEC, and the MEC employee updated his case and made him eligible for Commonwealth Care. I mentioned that I was curious about the number of Exceptions Forms I’d received. She told me that there was a recent mass mailing of Exceptions Forms sent regardless of whether applicants indicated their employer offered them insurance, and this mailing was intended to decrease the number of enrollees who were offered private insurance. She also informed me that self-employed people should not be on Commonwealth Care, but instead should sign up for the Insurance Partnership.
UPDATE: A follow-up call to the Taunton MEC assured me that the information from the previous MEC worker was incorrect. The reason for the increase in Exceptions Forms has to do with the new Federal Poverty Level (FPL) guidelines going into effect on April 1. According to this MEC worker, implementing the new FPL triggered a system-wide audit of all applications, including those where the applicant had not indicated whether or not they were offered employer-sponsored insurance.
CASE #2
Several months earlier, I’d spoken with a self-employed client who filled out her ERV but left blank the sections she did not understand. Weeks later, she was told her Commonwealth Care was ending because she indicated on her ERV that her employer offered her insurance, even though the client had simply left that section blank. When I called the Taunton MEC, the MEC employee said that I should “expect a lot more exceptions forms” because “anyone who didn’t specifically check off on their ERV that they were NOT offered insurance by their employer would be considered to have been offered insurance.”
CASE #3
At a health fair last summer, I encountered a 45 year-old single woman who worked at a “big box” retailer on the South Shore. Even though she worked as many as 39 hours a week, her employer classified her as “part time” and did not offer her insurance. She had some chronic illnesses, yet hadn’t been to a doctor in years because of her lack of insurance. She was skeptical at first, but thrilled when she was able to enroll in a Commonwealth Care plan.
Fast forward to March of 2008 when I got a dreaded message on my voicemail: The applicant from the previous summer was panicking because MassHealth had sent her a letter saying that her coverage was ending March 31st, and she already had a surgery scheduled for the end of April. I checked My Account Page and found that she’d been sent an Exceptions Form, meaning that at some point, MassHealth discovered or assumed that her employer offered her insurance. When I inquired, she told me that she’d asked her employer if they offered health insurance and was told “yes,” which she in turn reported to MassHealth.
I met the enrollee at her workplace and spoke with her human resources manager, who informed me that, yes; they offered a Limited Benefit Medical Plan to all part-time employees. The plan was entirely paid for by the employee, featured no prescription coverage, and had a yearly maximum benefit of $1000 – a plan so limited that employees would still be eligible for Commonwealth Care. After some discussion, the manager was horrified to learn that he had told several part-time employees that they were offered health insurance, and that as a result the state considered them ineligible for state-sponsored programs. This woman is still on Commonwealth Care, and a lot of her co-workers will be joining her in the near future.
I am very curious to hear if anyone else has encountered situations like these, and if anyone else has a case similar to #1 where an applicant was denied due to an Exceptions Notice even though on their application they indicated they were not offered insurance. Does anybody know why the MEC would assume that they have insurance? Is this a fluke?
Ditto - Ditto - Ditto
The flood of exceptions letters that we have seen at Outer Cape Health for people who have never been offered ESI is daunting. People are losing their CommCare because they don't respond; they don't believe the letter applies to them, and does not offer a box to say they have not been offered health insurance within the last 6 months (which they have already reported on their VG/ERF). Loss of prescription coverage has been the most devastating outcome. We are also seeing all new VG aps for self-employed people receiving exceptions letters, delaying CommCare eligibility determinations at least another month.
Reps from the Connector and MassHealth at the Taunton MTF last week were amazed at the entire room nodding in assent to this problem. I was successful calling the Taunton MEC to 'have it taken care of' on Monday for two patients.
exceptions forms
I too have had many clients getting exceptions forms, even though we marked "NO" on whether they are offered insurance. I have taken to including an exceptions form right up front with the Virtual gateway application. I fax it with the other documents and list it as "other". I don't know yet whether this actually helps or not.
This subject came up this
This subject came up this morning at the western MassHealth Training Forum meeting in Holyoke. An outreach worker checked the "NO" box for her client in answer to the questions about existing insurance and whether it had been offered within the past 6 months. Her client then received an Exceptions Form saying the application indicated existing insurance. Many heads were nodding at this point. The worker then called the MEC and was told that the "YES" box had been checked. Michael Norton, the presenter, said he would take the issue back to the Connector to be addressed.
Another difficulty with the Exceptions Form is that people often are in exceptions situations that don't appear on the form. There's no box to check. Michael Norton said that an attached letter explaining the situation, or even a note in the margin, would be read and considered -- and that the form wasn't cast in stone.
Thanks for this post, Keith.
Thanks for this post, Keith. It highlights exactly what we are seeing in great numbers here at the Health Care for All Helpline. Specifically, we are seeing members terminated from Commonwealth Care because MassHealth says that the applicant has stated that their employer "offered health insurance within the past six months." We have found that many of these terminations are wrongful. Many of our clients that have been terminated have never even had access to ESI from their current, nor any former employer! Others are paying out-of-pocket for unsubsidized coverage and should still be eligible for Commonwealth Care.
One specific case that comes to mind is a caller that we helped enroll into CommCare in June 2007. In March, this caller received a notice of Commonwealth Care termination to end 4/30/2008 because MassHealth said that she has access to ESI. The client also received an exceptions form. We spoke with the client and she is not offered ESI. Her employer doesn't offer ESI to any employee! We looked at her original application and we checked off that she did not have health insurance or access to health insurance through her employer. Unfortunately we had to tell the client that at no fault of her own, she would be terminated from Commonwealth Care unless she completed the Exceptions Form. We hope that the Exceptions Form will be processed in a timely manner as to prevent this caller from being terminated from Commonwealth Care.
I've seen much of the same
I've seen much of the same Keith, many many cases in which a person declared on a new application or eligibility review form that the employer didn't offer health insurance. I know this because we keep a copy of everything on file for everyone we work with.
In my opinion this "exceptions letter thing" is another situation where, something wasn't getting done that needed to get done, and the one-size-fits-all approach was employed, and the chips fall where they may. Except, the chips are people's health, they're un-filled prescriptions for insulin and psychiatric medications, they're interruptions in chemotherapy.
As an outreach advocate it's extremely frustrating when something new like the exceptions letter comes on line and we have no advance warning or education about the procedures of how to deal with it. I'm happy to help re-route the members that shouldn't be enrolled in Commonwealth Care, but next time it will be helpful if we have information before something like this explodes. It definitely undermines our credibility as advocates when we all we can say to our clients is, cross your fingers and hope you're Commonwealth Care gets turned back on the first of next month.
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