More March 27 Boston HAN: how to apply for a waiver or reduction of Commonwealth Care premiums and copayments

Notes from information presented by Georgia Maheras, Staff Attorney, Health Law Advocates, at our Health Access Network meeting in Boston, MA – March 27, 2008

The process for applying for a premium waiver is different from that for a co-pay waiver, and each uses a different form. However, both processes funnel into a Connector hearing and, if appealed, can then result in a Superior Court hearing.

If your client needs a waiver/reduction, call the Connector to request one. (Clients can be assisted through the 1-877-MA-ENROLL line by pressing "3" during the main menu to access the Commonwealth Care call center, and then continuing to select the menu option for "all other inquiries" until they reach a representative.) You may also choose to file a Representative Form (PDF) with your client, which is like a Permission to Share Information form for the Connector about the appeal.

After you call, the Connector will send a form in the mail to fill out and send back. For your reference, the Premium Waiver-Reduction Application (PDF) and Copayment Waiver Application (PDF) are on our website.

• If you are denied the waiver/reduction, you can file an appeal using the Connector’s Appeals Request Form (PDF). If your appeal is initially rejected, you can continue to appeal the case up to your Superior Court.

The Connector has complete discretion as to when to reduce or waive, or grant a payment plan. In our HAN discussion, one participant said that every waiver application is read by upper-level Connector staff, and that submissions that include an estimate of what a person could pay are appreciated.

There are a couple of “wonky” tips to be aware of if you apply for a premium waiver:

• You can apply for a waiver of your premium before you enroll in a plan, but you still have to pay the first month’s premium - otherwise, they can deny your enrollment in the plan. If the waiver’s approved, you’ll be reimbursed in 6-8 months.
• If you’re already in arrears and have received a cancellation notice, it is a good idea to get your Premium Reduction-Waiver Application to the Connector right away. Georgia reported that if the application is received at least five (5) business days before the end of the month the cancellation notice was sent, the Connector will not terminate you for non-payment while they’re making a decision about your waiver.

There are hardship criteria (PDF) for a waiver, though Health Law Advocates is pushing for the spirit rather than the letter of these criteria. In addition to the hardship criteria listed, you could also apply for other significant, unexpected increases in expenses (though you are less likely to be successful if the hardship does not fall within a listed category). Georgia encouraged us to hand tough cases over to Health Law Advocates as early as possible in the application process, so they can see it through the whole appeals process.