In response to the state fiscal crisis, the Executive Office of Health and Human Services has reduced the time MassHealth and some Commonwealth Care members have to return their eligibility review forms (ERVs).
As of December 15, 2008, MassHealth reduced the time MassHealth members have to return ERVs to 30 days. This change also applies to households with both Commonwealth Care and MassHealth members. Commonwealth Care-only households will still have 45 days to return ERVs. MassHealth members who are over 65 continue to have 30 days to return ERVs.
If the ERV form is not returned in time, the member may be terminated. When ERVs are returned in time but are not complete, members will receive a VC-1 form from MassHealth that must still be returned within 60 days.
ERV
I received many Mass Health letters notifying me that our patients are terminated for not submitting the review. With this change I would expect for these letters to triple. My staff is doing everything possible to get in touch with these patients and submitting over 200 review monthly; with this change it will increase dramatically the volume work and we will be facing many unpaid visits if the coverage does not go retro.
I also agree with Fran that 30 days is not enough.
Ivelisse Delgado
I would be nice if we could
I would be nice if we could take part in some kind of vote before rules like this one can be made.
We clean up the mess...
So, let me get this straight: As a result of the state's fiscal crisis, the turnaround time for ERVs is shortened. As a result, more people are terminated from their coverage. Then, community-based enrollment programs spend additional time to get these clients re-enrolled. As part of this process we spend more time on the phone with MECs, which uses more MassHealth staff time. In the meantime, while they are uninsured, these clients need medical care which they (a) forgo, resulting in increased burden of illness and possibly leading to costly emergency care rather than preventive care or (b)obtain services that are not covered, which either leads them further into debt or creates additional bad debt for providers. One more thing about the impact of this policy change: We, the community-based enrollment programs, are also adversely effected by the state's fiscal crisis. So as our capacity is diminished (for example, I am losing one position/employee, or 25% of my enrollment staff as a result of decreased funding), the demand on our services will increase as people realize they have lost their coverage and need help getting it back TODAY.
As always, we will do what needs to be done to keep people covered and help them manage during coverage gaps (to the best of our ability given our reduced capacity). I understand that the choice may have been between reducing benefits and shortening the turnaround time and the latter seemded like the lesser evil. I would ask the policy analysts to document the results and examine the consequences of this change closely, so we know what the real impact is.
ERVs
How sad that EOHHS is trying to save money by limiting access to health care for the neediest of residents. 30 days is really not enough time to get the ERV, complete it (especially if you need help), return it and have the MEC process it. This tightening of the time frame will only cause more work at both the enrollment centers (phone calls) and the Board of Hearings (appeals to protect coverage). I am sure if EOHHS ask those of us in the field or even at the MECs where money could be saved we could come up with better then this.
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