This post has been updated; it was originally submitted Jun 19 2008 - 10:32am.

Recap of the problem:

Approximately 16,000 Commonwealth Care members/applicants received delayed Commonwealth Care notices beginning on Tuesday, June 17. The delayed forms are dated as early as April 30. The delayed notices deny or terminate Commonwealth Care coverage for one of the following reasons:

• Potential access to other health insurance, such as: Qualified Student Health Insurance Plan (QSHIP), TriCare, Medical Security Program (MSP), or self-declared Employer-Sponsored Insurance (ESI)
• Failure to pay Commonwealth Care premiums for two months
• Potential access to Employer-Sponsored Insurance (the "Exceptions letter")

Some people who received delayed forms were denied or terminated from Commonwealth Care coverage as of May 31. Recipients of the forms who may in fact be eligible should submit an appeal.

• The Office of Medicaid has issued an official notice (PDF) explaining the problem and their plan to address it.
• Brian Rosman of Health Care For All gives an overview from an advocacy perspective on a recent post to the WBUR CommonHealth blog.

What people should do:

With delayed Exceptions letters:

• People who meet one of the Exceptions on the form, or who have been mistakenly identified as having access to ESI when they do not, should submit the delayed form within 30 days of receipt to the address given on the form: Exceptions Department, P.O. Box 9212, Chelsea, MA, 02150.
• People submitting the form should attach a copy of the June 18 cover letter – a.k.a. the "special insert" - that came with the delayed form. This will help flag the case for expedited processing.
• Recipients of delayed Exceptions forms who were left without coverage during the delay must return them before July 30 in order to qualify for reimbursement of medical expenses incurred. (Reimbursement applies only to people whom the Connector determines to have been eligible during the delay).
• Advocates have suggested that people who submit delayed Exceptions letters also submit an Appeals Request Form (PDF), again with a copy of the "special insert," to a separate address: Commonwealth Care Customer Service Center, PO Box 12008, Boston, MA 02112-9914

With delayed notices about access to other insurance:

• Those who may in fact be eligible for Commonwealth Care (i.e. who do not have access to other insurance) can dispute the decision through the Connector Appeals process. They should return the Appeals Request Form (PDF) (within 30 days of receipt) to: Commonwealth Care Customer Service Center, PO Box 12008, Boston, MA 02112-9914. They should attach a copy of the June 18 "special insert" to their Appeal, to flag the case for expedited processing.

With delayed termination notices for non-payment of premiums:

• Those who are experiencing "extreme financial hardship" should request a premium reduction/waiver. In addition, anyone having trouble making payments can call the Customer Service Center at 1-877-MA-ENROLL to request a payment plan.
• People who dispute their termination should return the Appeals Request Form (PDF) (within 30 days of receipt) to: Commonwealth Care Customer Service Center, PO Box 12008, Boston, MA 02112-9914. They should attach a copy of the June 18 "special insert" to their Appeal, to flag the case for expedited processing.

Regarding medical expenses during the delay:

• Members/applicants who are ultimately approved for Commonwealth Care (i.e. win the appeal) can receive reimbursement through MassHealth for necessary medical expenses incurred during the delay (between the termination date and the date coverage is reinstated).
• Those who plan to appeal the delayed notice or submit an Exceptions Form should save their receipts for any medical expenses, such as prescriptions, appointments, etc.
• Those who are deemed ineligible for Commonwealth Care (i.e. those who do have access to other insurance, lose the appeal or do not return the forms in time) will not be reimbursed for medical expenses.
• People who would anticipate reimbursement but are unable to pay for their medical needs in the meantime should contact Health Law Advocates at 617-338-5241 and Vicky Pulos or Neil Cronin at the Massachusetts Law Reform Institute at (617) 357-0700 (ext. 318 for Vicky and ext. 309 for Neil).

Individuals whose benefits were terminated, or who would like legal representation for their appeals hearing, should also contact Health Law Advocates at 617-338-5241 and Vicky Pulos or Neil Cronin at the Massachusetts Law Reform Institute at (617) 357-0700 (ext. 318 for Vicky and ext. 309 for Neil).

Sample delayed packet:

• Sample delayed Exceptions letter (PDF)
• Accompanying Commonwealth Care Appeals Request Form - with sample "special insert" (cover letter) (PDF)

Thank you to Kate Bicego at Health Care For All and Neil Cronin and Vicky Pulos at MLRI, for bringing this matter to our attention and keeping us up-to-date.