Commonwealth of Massachusetts Executive Office of Health and Human Services Office of Medicaid www.mass.gov/masshealth MassHealth Community Health Center Bulletin 67 March 2011 TO: Community Health Centers Participating in MassHealth FROM: Terence G. Dougherty, Medicaid Director RE: Revisions to the Medical Benefit Request, the Senior Medical Benefit Request, and the Virtual Gateway Background MassHealth has revised both the Medical Benefit Request (MBR) and the Senior Medical Benefit Request (SMBR) to clarify policy and capture applicant information to appropriately determine eligibility for individuals who are visitors to Massachusetts. The MBR has also been revised to include additional questions for households with an absent parent. There have also been changes to clarify current policy and reformatting changes. A new stand-alone absent parent form, Absent-Parent Questions and Assignment of Rights (AP-1), has been created. As a result, MA21, the Virtual Gateway (VG) Common Application, and MassHealth notices have been revised. These changes were effective January 1, 2011. Changes to the MBR, SMBR, and the VG MBR Revisions ? Instructions page: Additions were made to clarify the policy for working disabled members who do not work 40 hours a month. * Visitor (VIS) section: A new section was added with questions designed to determine whether visitors from other U.S. states, U.S. territories, or other countries who apply for benefits are eligible. * Unemployment Benefits (UIN) section: This section was revised to add questions for a second person. * College Student (STU) section: This section was reformatted. * Absent Parent (ABS) section: An additional trigger question was added to identify children who have been adopted by a single parent or who have a parent who is deceased or unknown. * Supplement B (Absent Parent): A new section was added to capture the information from the trigger question. Other changes include the following: (continued on next page) MassHealth Community Health Center Bulletin 67 March 2011 Page 2 Changes to the MBR,SMBR, and the VG (cont.) ? revising the instructions statement at the beginning of the form; ? moving the instructions statement from the second page to the first page; o revising the instructions in Part A about providing new information and changing the part identifiers (letters); o adding a new section—Part B—to capture the names of the children who were adopted by a single parent or have a parent who is deceased or unknown; o changing the identifiers to Parts C and D; and o adding the penalty of perjury statement to Part E and changing the identifier. SMBR Revisions * Instructions page: The revisions clarify the policy for working disabled members who do not work 40 hours a month. * Visitor (VIS) section: A new section was added with questions designed to determine whether visitors from other U.S. states, U.S. territories, or other countries who apply for benefits are eligible. * Unemployment Benefits (UIN) section: This section was revised to add questions for a second person. * Assets (ATT) section and Supplement A: Long-Term-Care Questions: The phrase “on or after February 8, 2006” was replaced with “in the past 60 months.” Virtual Gateway The Virtual Gateway has been updated to include all of the changes and additions for the MBR and the SMBR (with the exception of Supplement A: Long-Term-Care Questions). MA21 has been updated to import the information to the appropriate events. New Form Absent-Parent Questions and Assignment of Rights (AP-1) The Absent-Parent Questions and Assignment of Rights (AP-1) is a new, stand-alone form that contains the same information as the MBR Supplement B (Absent Parent). This form will be sent as part of the verification process if the absent parent questions are not answered on an application or review. Additionally, it will be used with existing cases when an absent parent is reported or when a child is added and only one parent is in the household. Visitor Information Individuals who are visitors to Massachusetts may be eligible for MassHealth benefits if they are applying due to an unexpected medical condition or situation that occurred after they arrived in Massachusetts and the condition or situation prevents them from leaving the state. Individuals who meet this requirement must meet all other eligibility requirements to be eligible for MassHealth. (continued on next page) MassHealth Community Health Center Bulletin 67 March 2011 Page 3 Visitor Information (cont.) The visitor questions will identify those individuals who may be eligible for benefits and those who do not meet the criteria for eligibility. These questions must be answered. If they are not answered, the application cannot be processed. Changes about Children in a Single-Parent Household Children who were adopted by a single parent or who have a parent who is deceased or unknown are not considered to have absent parents. The new trigger question on the MBR and the additional section on Supplement B of the MBR and the AP-1 were added to ensure that children who fall into this category are identified and properly coded. This will prevent MA21 from including these children in requests for verifications about absent parents. Responses for Good Cause (Part C) and absent parent (Part D) are now required. MA21 has been programmed to send an AP-1 as part of the verification process to households with children in a single-parent household who have not provided the absent parent information. Questions If you have any questions about the information in this bulletin, please contact MassHealth Customer Service at 1-800-841-2900, e-mail your inquiry to providersupport@mahealth.net, or fax your inquiry to 617-988-8974.