Commonwealth of Massachusetts
Executive Office of Health and Human Services
Office of Medicaid
600 Washington Street
Boston, MA  02111
www.mass.gov/masshealth	

		MassHealth
		Eligibility Letter 133
	June 15, 2005

TO:	MassHealth Staff
FROM:	Beth Waldman, Medicaid Director

RE:	Revised Guidelines for Waiver or Reduction of MassHealth Premium Due to Extreme Financial Hardship

MassHealth is revising the guidelines used to determine extreme financial hardship when members request a reduction, or waiver, of their MassHealth premium.

These revisions clarify the conditions under which a reduction or waiver of the applicable MassHealth premium can be granted, as it relates to medical and dental expenses.  

These revisions further clarify both the starting date of the agreed MassHealth premium reduction or waiver period, and the steps required for a member’s voluntary withdrawal from MassHealth.

These regulations are effective June 15, 2005.

	MANUAL UPKEEP									
Insert	Remove	Trans. By	
			
506.011 (3 of 6)	506.011 (3 of 6)	E.L. 121	

	130 CMR:  DIVISION OF MEDICAL ASSISTANCE

Trans. by E.L. 133	

Rev. 06/15/05	
	MASSHEALTH
	FINANCIAL REQUIREMENTS
		(3 of 6)	

Chapter
Page	

506
506.011	

(F)  Waiver or Reduction of Premiums for Extreme Financial Hardship.

	(1)  Extreme financial hardship means that the member has shown to the satisfaction of the MassHealth agency that the member:

(a)  is homeless, or is more than 30 days in arrears in rent or mortgage payments, or has received a current eviction or foreclosure notice;

(b)  has a current shut-off notice, or has been shut off, or has a current refusal to deliver essential utilities (gas, electric, oil, water, or telephone);

(c)  has medical and/or dental expenses, totaling more than 7.5% of the family group’s gross annual income, that are not subject to payment by the Uncompensated Care Pool, and have not been paid by a third-party insurance, including MassHealth (in this case “medical and dental expenses” means any outstanding medical or dental services debt that is currently owed by the family group, regardless of the date of service); or

(d)  has experienced a significant, unexpected increase in essential expenses within the last six months.

	(2)  If the MassHealth agency determines that the requirement to pay a premium results in extreme financial hardship for a member, the MassHealth agency may, in its sole discretion, waive payment of the premium or reduce the amount of the premiums assessed to a particular family.

	(3)  Hardship waivers will be authorized for six months.  The six-month time period begins in the month after a documented hardship request is granted.  At the end of the six-month period, the member may submit another request.  Requests for premium relief should be addressed to the MassHealth agency.  

(G)  Voluntary Withdrawal.  If a member wishes to voluntarily withdraw from receiving MassHealth coverage, it is the member’s responsibility to notify the MassHealth agency of his or her intention by phone or, preferably, in writing.  Coverage continues through the end of the calendar month of withdrawal.  The member is responsible for the payment of all premiums up to and including the calendar month of withdrawal.