Commonwealth of Massachusetts Executive Office of Health and Human Services Office of Medicaid 600 Washington Street Boston, MA 02111 www.mass.gov/masshealth Eligibility Operations Memo 10-08 May 1, 2010 TO: MassHealth Eligibility Operations Staff FROM: Russ Kulp, Director, MassHealth Operations RE: Revisions to the Medical Benefit Request and MA21 Screen Changes Introduction MassHealth has revised the Medical Benefit Request (MBR) form to capture applicant information needed to determine eligibility for MassHealth, Commonwealth Care, and Health Safety Net benefits. As a result of the changes to the MBR, MA21, the Virtual Gateway Common Intake Application, and MassHealth notices have also been revised. MBR Changes The revised MBR contains the following changes: * Working Income section (EIN): The questions were revised to include applicants’ responses about employment in the last 12 months (formerly in the “Not Working or College Student” section). * Not Working or College Student section (LTU): This section has been removed. The questions have been relocated to other sections of the application. * Nonworking Income section (UIN/REN): This section has been revised to capture information about income from unemployment compensation (formerly in the “Not Working or College Student” section). In addition, a new question has been added to capture information about rental income. * College Students section (STU): This new section captures information related to the availability of health insurance due to enrollment in a college or university (formerly in the “Not Working or College Student” section). * Health Insurance — Part B: Subsidized Health Insurance section: New questions have been added to capture details about the uniformed services. * Injury, Illness, or Disability section: This section has been revised, removing the second and third questions and inserting a new question about accident or injury. * Supplement A — Accident or Injury section: This section has been reformatted. (continued on next page) MBR Changes (cont.) ? Obsolete Question: The question “Is your spouse working more than 100 hours a month?” has been removed from the MBR. MA21 will determine this by looking at family group relationships and EIN information. Supplies of the revised MBR are available and providers will be notified in Acute Inpatient Hospital Bulletin 138 and Community Health Center Bulletin 65. They will be advised to continue to use the previous version of the MBR until their supply is exhausted. Other Revised Forms The following forms are in the process of being revised to incorporate similar changes. * Eligibility Review Forms (ERV-1, ERV-5, and ERV-9); * Senior Medical Benefit Request (SMBR); and * Eligibility Review for Seniors and Certain People Needing Long-Term-Care Services (MER, MER-PDD, and MER/TRANS). MA21 System Changes In order to support the changes to the MBR, MA21 screens have been modified and a new event, College Students (STU), has been created. * LTU (Long Term Unemployed): The questions in this event have been relocated to the EIN, UIN, and STU events. The LTU event will continue to be available for query purposes only. * EIN (Earned Income): A trigger question—“Are you working?”—has been added. Questions about employment in the past 12 months have been relocated. * UIN (Unearned Income): Questions related to unemployment compensation have been relocated and a trigger question—“Do you have any other income?”—has been added. * REN (Rental Income): A trigger question—“Do you or any family member have any rental income?”—has been added. * STU (College Students): This is a new event. It will be used to capture information about access to insurance due to enrollment in a college or university. * HIN (Health Insurance): The trigger question—“Do you or any family member have health insurance other than Medicare?”—has been added. * SIA (Potential Access to Government-Subsidized Insurance): New questions have been added to capture information to determine access to TRICARE. * TPR (Third Party Recovery): The trigger question—“Do you or any family member need health insurance because of an accident or injury?”—has been added. (continued on next page) MA21 System Changes (cont.) MA21 has also been enhanced to allow the data entry of an applicant’s responses including “yes,” “no,” and blank responses. See the attached chart for more information. Blank responses to trigger questions will be identified in reports for use by MassHealth Operations and the Department of Health Care Financing and Policy (DHCFP) staff to determine future changes to eligibility rules. MA21 will continue to send requests for information (VCs) to applicants and members when they have unverified information. Virtual Gateway and Importing to MA21 Effective March 29, 2010, the Virtual Gateway will be enhanced to correspond to the changes made to the paper MBR. The import of a Virtual Gateway MBR or SMBR to MA21 will continue as usual. All new questions will be imported to the appropriate MA21 event, including the new STU event. Any response provided on a Virtual Gateway application, including “no” responses or blank responses, will be imported to MA21. New Action Reason If a worker receives an eligibility review form that has multiple trigger questions left unanswered, the worker may use the new action reason IN (incomplete application) to inform the applicant that the application is being denied for lack of information. Missing critical data (MCD) processes currently used by the Central Processing Unit (CPU) for MBRs with missing information have not changed. CPU may use the new action reason for HSN reviews that are incomplete. Attachment The attached chart provides information about the changes to the application and data entry on MA21 and how the changes affect eligibility determinations. Questions If you have any questions about this memo, please have your MEC designee contact the Policy Hotline. Eligibility Operations Memo 10-08 May 1, 2010 Attachment Page 1 Working Income Section Question Description of Change Old Event New Event Defaults (may change defaults to Y/N/B) Responses (Y = Yes, N = No, B = Blank) Is this person currently working? Note: Removed from LTU section New trigger question added to MA21 n/a EIN * under age 19 – default to No * aged 19-64 – will not default – worker must enter response * aged 65 or older – default to No * Y – must enter at least 1 occurrence of earned income – press PF4 to add new employer * N – requires responses to unemployment questions * B – individual will not be considered LTU Has this person worked in the past 12 months? Moved to new event LTU EIN * under age 19 – default to No * aged 19-64 – will not default – worker must enter response * aged 65 or older – default to No * Y – required to complete amount of earnings in past 12 months * N or B – no further data entry allowed – individual will not be considered LTU Amount earned in past 12 months? Moved to new event LTU EIN * No default * Enter in dollar amount – if left blank, individual will not be considered LTU Offers health insurance? Changed defaults EIN EIN * No default – mandatory for each active employer * Y – individual has potential access to ESI * N – must enter response to next question * B – treated same as Yes response Was HIN offered in last 6 months? Changed defaults EIN EIN * No default – mandatory for each active employer * Y – individual has potential access to ESI * N – individual does not have potential access to ESI * B – treated same as Yes response Eligibility Operations Memo 10-08 May 1, 2010 Attachment Page 2 Nonworking Income – Unemployment Benefits Section Question Description of Change Old Event New Event Defaults (may change defaults to Y/N/B) Responses (Y = Yes, N = No, B = Blank) Are you getting an unemployment check? Moved to new event LTU UIN * under age 19 – default to No * aged 19-64 – will not default – worker must enter response * aged 65 or older – default to No * Y – must enter at least 1 occurrence of UNEMP income type in the UIN event * N – business as usual * B – individual will not be considered LTU If yes, is this check from Commonwealth of MA? Moved to new event LTU UIN * under age 19 – default to No * aged 19-64 – will not default – worker must enter response * aged 65 or older – default to No * Y – must enter response to next question * N – business as usual * B – treated same as Yes response for purpose of CommCare eligibility If yes in the past 12 months before this person became unemployed, did they work for an employer of Massachusetts? Moved to new event LTU UIN * under age 19 – default to No * aged 19-64 – will not default – worker must enter response * aged 65 or older – default to No * Y – business as usual * N – business as usual * B – treated same as Yes response for purpose of CommCare eligibility Eligibility Operations Memo 10-08 May 1, 2010 Attachment Page 3 Nonworking Income – Rental Income Section Question Description of Change Old Event New Event Defaults (may change defaults to Y/N/B) Responses (Y = Yes, N = No, B = Blank) Do you or any other family member have rental income? New trigger question added to MA21 and MBR n/a REN * default to No * Y – must enter at least 1 occurrence of rental income – press PF4 to add * N – business as usual * B – treated same as No response Other Nonworking Income Section Question Description of Change Old Event New Event Defaults (may change defaults to Y/N/B) Responses (Y = Yes, N = No, B = Blank) Do you have any other income? New trigger question added to MA21 n/a UIN * under age 19 – default to No * aged 19-64 – will not default – worker must enter response * aged 65 or older – default to No * Y – must enter at least 1 occurrence of income in the UIN event other than UNEMP * N – business as usual * B – treated same as No response College Student Section Question Description of Change Old Event New Event Defaults (may change defaults to Y/N/B) Responses (Y = Yes, N = No, B = Blank) Are you or any family member a college student? New trigger question added to MA21 and MBR n/a STU * under age 19 – default to No * aged 19-25 – * unemployed – will not default – worker must enter response * employed – default to No * aged 26 or older – default to No * Y – must enter Y/N/B to remaining college student questions * N – business as usual * B – treated same as No response Eligibility Operations Memo 10-08 May 1, 2010 Attachment Page 4 College Student Section (cont.) Question Description of Change Old Event New Event Defaults (may change defaults to Y/N/B) Responses (Y = Yes, N = No, B = Blank) Is this person eligible for health insurance from college? Moved to new event LTU STU No defaults * Y – business as usual * N – business as usual * B – treated same as No response Is this person a college student at a school in MA with at least 75% of a full- time schedule? Moved to new event LTU STU No defaults * Y – business as usual * N – business as usual * B – treated same as No response Is the student planning to get health insurance from the school but is waiting for the coverage to start? Moved to new event LTU STU No defaults * Y – business as usual * N – business as usual * B – treated same as No response If yes, what is the date that the school health insurance coverage starts? Moved to new event LTU STU No defaults * required to enter a date if the previous question is a Yes response. * Health Insurance Section Question Description of Change Old Event New Event Defaults (may change defaults to Y/N/B) Responses (Y = Yes, N = No, B = Blank) Do you or any family member have health insurance other than Medicare? New trigger question added to MA21 n/a HIN * default to No * Y – must enter at least 1 occurrence of HIN other than Medicare – press PF4 to add new HIN record * N – business as usual * B – treated same as No response Eligibility Operations Memo 10-08 May 1, 2010 Attachment Page 5 Part B: Subsidized Health Insurance You May Be Eligible For Section Question Description of Change Old Event New Event Defaults (may change defaults to Y/N/B) Responses (Y = Yes, N = No, B = Blank) Are you or any family member who is aged 19 or older currently earning 50% or more of the family’s total income from working in the commercial fishing industry? Changed defaults n/a SIA * default to No * Y – business as usual * N – business as usual * B – treated same as Yes response Are you or any family member in one of the uniformed services? Modified MBR and added trigger question to MA21 n/a SIA * default to No * Y – must have a Yes response to at least one of the four military questions below * N – business as usual * B – treated same as No response Active Duty? New question n/a SIA * default to No * Y – access to TRICARE * N – business as usual * B – treated same as No response Retiree? New question n/a SIA * default to No * Y – access to TRICARE * N – business as usual * B – treated same as No response Reserves? New question n/a SIA * default to No * Y – access to TRICARE * N – business as usual * B – treated same as No response Medal of Honor? New question n/a SIA * default to No * Y – access to TRICARE * N – business as usual * B – treated same as No response Eligibility Operations Memo 10-08 May 1, 2010 Attachment Page 6 Injury, Illness, or Disability Section Question Description of Change Old Event New Event Defaults (may change defaults to Y/N/B) Responses (Y = Yes, N = No, B = Blank) Do you or any family member need health care because of an accident or injury? Combined TPR trigger questions on page 5 of MBR and added trigger question to MA21 n/a TPR * default to No * Y – must enter at least 1 occurrence of TPR Accident – indicate member(s) in bottom left hand corner of screen * N – business as usual * B – treated same as Yes response Obsolete Questions – The following questions have been removed from the MBR/SMBR. Question Description of Change Old Event New Event Is this person not working (unemployed)? This question has been deleted from the MBR/SMBR. The information is captured in the revised “Working” section. LTU EIN If married, is your spouse working 100 hours or more a month? This question has been deleted from the MBR/SMBR. MA21 will determine the answer to this question behind the scenes based on family group relationships and EIN information for other household members coded as “spouse.” LTU n/a