Our last Boston HAN meeting came in the wake of the Connector Board’s decisions to raise co-pays and premiums for Commonwealth Care, which shifts more of the costs of Health Care Reform to consumers. The ACT!! Coalition and other advocacy organizations continue to oppose these kinds of increases and push for sharing the costs more evenly with businesses. Meanwhile, outreach and enrollment workers are seeing an increase in administrative barriers to enrollment in Commonwealth Care and MassHealth.
System Glitches?
Homeless people who have checked off the “homeless box” on the Medical Benefit Request (MBR) form do not need to respond to mailed Eligibility Review Verification forms (ERVs) in order to maintain coverage. Some outreach workers fear they are being expected to respond to ERVs anyway, since they have seen several homeless clients kicked off MassHealth lately.
Many others are losing Commonwealth Care eligibility after receiving an Exceptions Notice, which is sent to anyone who may have been offered employer-sponsored insurance within the past six months. Last week in our blog, outreach workers gave some detailed examples of health access barriers related to Exceptions Notices.
Some people who are approved for Social Security have also been unexpectedly terminated from Commonwealth Care; outreach workers are concerned that MassHealth is assuming that if applicants have Social Security, they also have Medicare – even if they do not.
The gap between MassHealth and CommCare
Switching from MassHealth to Commonwealth Care remains a problem for people with chronic conditions or urgent prescription needs, because MassHealth terminates coverage in the middle of the month while Commonwealth Care does not begin until the first of the next month. Given that the two programs already work together, outreach workers at HAN were wondering: can’t this gap be closed?
During our community update discussion we heard the story of one client who lost her prescription coverage as she switched from MassHealth Standard to Commonwealth Care. She was waiting for a kidney transplant and needed the medications immediately – but they cost $6,000. After meeting a dead end with MassHealth, her family spoke with their State Representative and, luckily, she was able to get the medications from MassMedline.
Retroactive enrollment in Commonwealth Care
We keep hearing about clients who have had to wait an extra month or two for their Commonwealth Care coverage to begin because of administrative errors. There has been no retroactive coverage available to cover the costs incurred since the date the coverage was supposed to take effect – even for people with pressing health care needs like the woman above.
A lawsuit has changed this for one person. Health Law Advocates filed a lawsuit on behalf of a client whose cancer surgery fell in the gap between her Prior Approval and the date her Commonwealth Care coverage later took effect (delayed by an administrative error by the program). Though she was initially told she could not be reimbursed for the surgery, Commonwealth Care agreed to retroactively enroll her in the health plan after the lawsuit was filed.
This case signifies the first retroactive enrollment in Commonwealth Care, but it has not yet resulted in any policy change for coping with administrative errors. If one of your clients has a similar case – and very well-documented records of what has happened, including evidence the client was not at fault for the error – you can get in touch with Health Law Advocates at 617-338-5241.
How to help clients having trouble with Health Care Reform
Georgia Maheras of Health Law Advocates discussed how to help clients concerned about meeting the requirements of the individual mandate. People having trouble paying Commonwealth Care premiums and co-payments can apply for a waiver or reduction of the costs. For details and helpful tips from Georgia, please see our notes about How to Apply for a Waiver or Reduction of Commonwealth Care Premiums and Copayments.
Those who haven’t been able to get affordable insurance at all can appeal the tax penalties. Georgia explained how to fill out Schedule HC, the health care form we all must file with our MA state income tax returns; you can see guides to filling out this form online from Health Care For All and the Department of Revenue. For help appealing the individual mandate penalties, you can see the guide to how to appeal the individual mandate penalty (PDF) that Community Partners assembled based on Georgia’s advice.
Do you have anything to add to the discussion we started at HAN? Any lingering questions about helping clients cope with the individual mandate? Feel free to post your comments.
Post new comment