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 141 February 1, 2006 TO: MassHealth Staff FROM: Beth Waldman, Medicaid Director RE: MassHealth Essential: Removal of Sponsor Requirement for Aliens with Special Status MassHealth is revising its regulations to remove the eligibility requirement that aliens with special status (AWSS) provide information about their sponsor and the sponsor's ability to provide financial support the applicant or member. These emergency regulations are effective February 15, 2006. MANUAL UPKEEP Insert Remove Trans. By 505.007 (4 of 4) 505.007 (4 of 4) E.L. 129 519.013 519.013 E.L. 129 130 CMR: DIVISION OF MEDICAL ASSISTANCE Trans. by E.L. 141 Rev. 02/15/06 MASSHEALTH COVERAGE TYPES (4 of 4) Chapter Page 505 505.007 (D) Funding. State legislation does not provide funding for MassHealth Essential after September 30, 2005. MassHealth Essential benefits will not be provided after September 30, 2005, unless a legislative extension is authorized. MassHealth Essential members who are receiving MassHealth Essential on September 30, 2005, will be provided only MassHealth Limited coverage as of October 1, 2005, if otherwise eligible for MassHealth Limited under 130 CMR 505.008. (E) MassHealth Essential for Aliens with Special Status. (1) Eligibility Requirements. MassHealth Essential for aliens with special status is available to adults aged 19 through 64 who meet the eligibility requirements of 130 CMR 505.007, except that they must be aliens with special status, as described in 130 CMR 504.002(D), and in addition to being long-term unemployed, they must be disabled, as described in 130 CMR 505.002(F)(2)(a). (2) Availability of Benefits. MassHealth Essential for aliens with special status is available either through the purchase of medical benefits or through premium assistance payments. Benefits may begin no earlier than June 1, 2004, except as described in 130 CMR 505.007(E)(2). (3) Funding and Enrollment Restrictions. MassHealth Essential members who are aliens with special status are subject to enrollment restrictions described in 130 CMR 501.003(C). Upon advance notice, MassHealth Essential benefits may be terminated if the MassHealth agency determines that there is insufficient funding. (4) Eligibility for MassHealth Limited. MassHealth Essential members who meet the requirements of 130 CMR 505.007(E) are automatically eligible for MassHealth Limited coverage. Medical services are provided pursuant to 130 CMR 450.105(G). MassHealth members meeting the requirements of 130 CMR 505.007(E) are eligible for MassHealth Limited benefits as follows. (a) For MassHealth Essential members with purchase of medical benefits, medical coverage begins in accordance with 130 CMR 505.008(B). (b) For MassHealth Essential members with premium assistance, medical coverage begins in accordance with 130 CMR 505.008(B) and is provided on a fee-for-service basis covering only MassHealth-covered services that are not covered by the member’s private health insurance. 130 CMR: DIVISION OF MEDICAL ASSISTANCE Trans. by E.L. 141 Rev. 02/15/06 MASSHEALTH COVERAGE TYPES Chapter Page 519 519.013 519.013: MassHealth Essential (A) Eligibility Requirements. MassHealth Essential is available to community residents aged 65 and older who are aliens with special status as described in 130 CMR 518.002(D), and who meet the following requirements: (1) the countableincome amount, as defined in 130 CMR 520.009, of the individual or married couple living together is less than or equal to 100 percent of the federal poverty level; and (2) the countable assets of an individual are $2,000 or less, and those of a married couple living together are $3,000 or less. (B) Financial Standards Not Met. Individuals whose income, assets, or both exceed the standards set forth in 130 CMR 519.013(A) may establish eligibility for MassHealth Essential by reducing their assets in accordance with 130 CMR 520.004, meeting a deductible as described at 130 CMR 520.028 et seq., or both. (C) Benefits. Individuals eligible for MassHealth Essential are eligible for medical benefits on a fee-for-service basis as defined in 130 CMR 515.001. These medical benefits are described in MassHealth regulations at 130 CMR 450.105(I). (D) Coverage Date. The begin date of medical coverage is established in accordance with 130 CMR 516.005, but no earlier than June 1, 2004. MassHealth Essential members are eligible for medical coverage under MassHealth Limited prior to June 1, 2004, if otherwise eligible for MassHealth Limited as described in 130 CMR 519.009. (E) Funding and Enrollment Restrictions. MassHealth Essential members who are aliens with special status are subject to enrollment restrictions described in 130 CMR 501.003(C). Upon advance notice, MassHealth Essential benefits may be terminated if the MassHealth agency determines that there is insufficient funding.