|
Staff Access
Basic Needs
Health Care Coverage
Health Safety Net Trust Fund (Formerly "Free Care")
Important note- eligibility changes went into effect in June 2016.
- Retroactive coverage- the start date for covered services is cut from 6 months retroactive from date of application to 10 days (effective 6/1/16).
- FULL HSN income limit decreases from 200% of the Federal Poverty Level to 150% FPL and the partial HSN deductible begins after 150% FPL instead of 200% (effective 6/23/16).
- The maximum income for PARTIAL HSN declines from 400% of the federal poverty level (FPL) to 300%. Though that those with high medical expenses may still qualify under “medical hardship” based on medical bills in excess of a certain percentage of income (effective 6/23/16).
- Households determined eligible for Connector Care lose HSN eligibility after 90 days of HSN eligibility except for dental coverage (pre-existing policy, but will now be enforced).
-More info: HSN Cuts Update and HSN Expiring for those Eligible for ConnectorCare Who Fail to Enroll, MGH Community News, May 2016,Health Safety Net Restrictions Planned for April 1st, MGH Community News, February 2016 and Analysis of Proposed Health Safety Net (HSN) Cuts, MGH Community News, March 2016.
Key resources:
Member Booklet rev 4/16 (Large Print version.)
- Combined member booklet for MassHealth, the Children’s Medical Security Plan (CMSP), ConnectorCare Plans and Premium Tax Credits, and the Health Safety Net. To get this booklet in Cambodian, Chinese, Haitian Creole, Laotian, Brazilian Portuguese, Russian, Vietnamese, or in Braille please call MassHealth Customer Service at 1-800-841-2900 (TTY: 1-800-497-4648)
Health Safety Net website- Mass.gov
Health Safety Net regulations (see especially "Health Safety Net Eligible Services".)
Sections:
Health Safety Net Basics
Background
Health Safety Net Trust Fund (HSN), formerly the Uncompensated Care Pool (or "Free Care"), reimburses health care facilities on a claims-basis for care provided to Massachusetts residents, including undocumented immigrants, who are uninsured or underinsured.The HSN is primarily financed by hospital and health plan assessments to reimburse hospitals and Community Health Centers for uncompensated care. Eligibility depends on household income, and in some cases, the level of medical expenses. Since Massachusetts' health reform, and the later implementation of the Affordable Care Act, the Health Safety Net is now primarily for those who don't qualify for other programs, those without a legal immigration status and those who need wrap-around coverage. Example of those who use HSN include those awaiting activation of their insurance (two in nine HSN claims) elders for costs not covered by Medicare or to cover gaps in coverage and legally authorized immigrants awaiting eligibility for comprehensive health insurance coverage, including survivors of persecution and domestic violence.
Covered Services
HSN covers services at participating hospital and communit health centers. It follows the MassHealth Standard benefit package for inpatient and outpatient care, but does NOT include other MassHealth Standard covered services offered via other providers such as transportation, inpatient rehab or long-term care. The program uses a combination of financial incentives and regulations to encourage/require the use of community health centers rather than hospital clinics for primary care. See Critical Access provisions and cost-sharing sections for detail.
Some services that may be covered by the Health Safety Net include: inpatient, outpatient, and emergency services. Doctor's fees are not covered (but MGPO policy is for MDs to discount their services 70% for those on full HSN. Also
see MGPO Credit Collection Policy).
Dialysis is a covered services, but this does not mean that patients have ready access to these services. Free-standing dialysis centers not licensed by a hospital are not reimbursed by HSN. So in reality it means that these patients need to get dialysis at a hospital or health center.
Transplant - while hospital transplant services are 'covered', MD fees are not (see note above for MGPO policy), so at least some transplant programs do not offer transplants to those with HSN only.
Pharmacy Services- detailed coverage chart (facilities with on-site outpatient pharmacies may submit claims to HSN for prescriptions). --Chart from Partners Community Benefits.
Dental- Note about MassHealth coverage- ss of January 2021, most adult dental benefit coverage has been restored under MassHealth. (These benefits had been cut In July 2010 and after many years of advocacy slowly restored over the years. See our Dental/Vision/Hearing page for more on MassHealth coverage). Health Safety Net (HSN) covers services at community health centers, and hospital-licensed centers, that have dental clinics (not at hospitals or private dentists' offices).
For MassHealth members, the Health Safety Net pays only for adult dental services provided by a Community Health Center, Hospital Licensed Health Center, or other Satellite Clinic that are not covered by MassHealth (HSN does not cover dental care at private dentists's offices or hospitals other than through a satellite dental clinics).
For patients enrolled in the Premium Assistance Payment Program Operated by the Health Connector, the Health Safety Net pays only for dental services not otherwise covered by the Connector plan. The Health Safety Net does not pay Connector copayments.
The Health Safety Net will pay for the following services at Community Health Centers, Hospital-Licensed Health Centers and Satellite Clinics if not covered by other insurance (see above).:
• Restorative (fillings);
• Endodontic (root canal);
• Periodontic (deep scaling);
• Crowns;
• Dentures (full, partial, or repair);
• Surgical procedures related to full or partial dentures.
-Above from: Division of Health Care Finance and Policy Health Safety Net (HSN) Claim Update: Health Safety Net Dental Services
Capacity at health center dental clinics, however, is extremely tight.
Find Health Centers with Dental services: HSN Dental Locations (PDF) | Excel
Eligibility
- Must be a Massachusetts Resident
- Excerpt of regulation: A person living in the Commonwealth of Massachusetts with the intention to remain as defined by 130 CMR 503.002(A) through (D).
Persons who are not considered residents are
- individuals who came to Massachusetts for the purpose of receiving medical care in a setting other than a nursing facility, and who maintain a residence outside of Massachusetts
- (More in regulations -see "Health Safety Net Eligible Services" and search for definition of "resident")
- There is no citizenship requirement, but must verify identity.
- Proof of identity: if no government issued ID, see member booklet pp 43-44 for alternatives. If no document available affidavit signed, under penalty of perjury, by another person who can reasonably attest to the applicant’s identity. (Does not need to be notarized) Should include name, address, physical description (age, sex, race, height, weight, eye color), how they know each other and for how long.
- Patients with limited incomes may qualify as Low Income Patients (see below).
- Patients with higher income, but large medical bills may qualify - See Medical Hardship below.
- For some limited circumstances there is also program called HSN Confidential.
Low Income Patients
- Massachusetts residents with household incomes less than 150% FPL as of 6/23/16 (formerly 200% FPL) who are ineligible for MassHealth, ineligible for ConnectorCare (except may have HSN for 90 days while enrolling in Connector Care), and who do not have access to affordable insurance (as defined by the Connector’s affordability schedule) (Full HSN).
- those with incomes between 151% and 300% FPL (formerly 201-400% FPL) after meeting a deductible equal to 40% of income in excess of 150% FPL who do not have access to affordable coverage as defined by the Connector's affordability schedule. (Partial HSN)
- If any member of the Premium Billing Family Group (PBFC) has an FPL below 150%, there is no deductible for any member of the PBFG.
Medical Hardship
- There are no income limits for Medical Hardship. One qualifies for Medical Hardship if the family's allowed medical bills are higher than a specified percentage of the family's income.
This is a retrospective eligibility type, for services delivered up to 12 months before the application date.
- The applicant's allowable medical expenses must
exceed a specified percentage of the applicant's gross income as follows:
| Income Level |
Percentage of Gross Income in Medical Expenses |
| 0 - 205% FPL |
10% |
| 205.1 - 305% FPL |
15% |
| 305.1 - 405% FPL |
20% |
| 405.1 - 605% FPL |
30% |
| >605.1% FPL |
40% |
-Source http://www.mass.gov/eohhs/docs/eohhs/eohhs-regs/101-cmr-613.pdf, 613.05 (1)(c), 4/16
HSN Confidential is a program for minors seeking treatment for sexually transmitted diseases and/or family planning services, and for survivors of domestic violence who have a reasonable fear of domestic violence. Providers may only submit claims for confidential services when no other source of funding is available to pay for the services confidentially. This eligibility type must be renewed annually with the assistance of a provider.
HSN As Secondary Coverage – Wrap-Around
HSN as Secondary Coverage to private insurance, Medicare, and certain MassHealth programs (Limited, Emergency Aid to Elders, Disabled and Children [EAEDC], Family Assistance Children*, Buy-In, Senior Buy-In, Children’s Medical Security Plan [CMSP]): HSN will pay for all eligible services as long as they are not covered by the primary. 10 day retroactive HSN eligibility (prior to 6/1/16 offered 6 months of retroactive coverage)
*Family Assistance/Premium Assistance Children – minors enrolled in Family Assistance/Premium Assistance who do not get MassHealth wrap to Family Assistance levels.
Note: Limited and CMSP do not require verification of identity. HSN secondary eligibility will only be available if the patient has provided verification of identity.
HSN as Secondary Coverage to other comprehensive MassHealth programs (Standard, CommonHealth, CarePlus, all other Family Assistance):
HSN will pay for certain dental services, and for outlier days for adults.
HSN as Secondary Coverage to ConnectorCare - HSN will pay for dental services not covered by the ConnectorCare plan
ConnectorCare eligible members will have HSN eligibility for up to 100 days after the medical coverage date (10 days before the date of application in most cases). If the member has not enrolled after 100 days, HSN eligibility will end. If the member enrolls after the 100th day, HSN will be available again between when the member enrolls and when their Connector Care coverage begins.
HSN as Secondary Coverage to other QHP (subsidized or nonsubsidized): HSN will pay for eligible services not covered by the QHP and for those with or without subsidies HSN will provide gap eligibility until their coverage start date.
(This section adapted from: The Health Safety Net (HSN) under the Affordable Care Act (ACA), MassHeath Training Forum 1/14.)
Cost Sharing
Deductibles, co-insurance and co-pays in presence of another insurer:
- Those with Private insurance: HSN Secondary will pay for deductibles and co-insurance, but not co-payments required by a private insurance plan.
- MassHealth: HSN will not pay for co-pays or CommonHealth deductibles.
- Medicare: HSN will pay for Medicare co-insurance, co-pays, and deductibles (though Medicare members are responsible for HSN co-pays).
There is no cost sharing for
- services provided at Community Health Centers or Hospital Licensed Health Centers except for co-payments for prescription drugs (part of efforts to encourage care at CHCs rather than hospitals)
- children age 18 and under
- those with incomes below 100% FPL, except for prescription drug co-pays
- those with incomes between 150 and 300% (formerly 201% and 400%) of the FPL, except for co-payments for prescription drugs (this group, however, is subject to significant deductibles)
Co-Pays: Adults with family income between 101% and 200% of the FPL are responsible for co-payments for the following SERVICES (see below for PHARMACY co-pays):
- $5 Outpatient routine visit (including therapy visits) at a hospital subject to the Critical Access provision, (i.e., MGH).
- $50 Inpatient Admission
- $50 Emergency Room visit - waived if admitted.
- There is no co-payment for an ancillary service visit that is solely for the purpose of a test or treatment that does not involve a face to face visit with a medical clinician.
- The annual maximum co-pay for those with income between 0 and 200% of the FPL is $250. ($200 on prescription drug co-pays and $50 on medical services co-pays). It is
the responsibility of the patient and provider to track co-pays. It's unclear
how providers will be able to do this, since a patient may be getting services
at other facilities.
Co-Pay Comparison Grid --From Partners Community Benefits, 12/07
Prescription Drug and "Wrap" Coverage
Pharmacy Co-Pays: All adults have pharmacy co-pays. This includes anyone over age 18 on Primary or Partial HSN. For those on Partial HSN, these co-pays do not count against a patient's Partial HSN deductible.
The pharmacy co-payments are (for those over 21):
- $1 for generic drugs in the following drug classes: antihyperglycemics, antihypertensives, and antihyperlipidemics;
- $3.65 for generic drugs for all other conditions.
- $3.65 for brand name drugs.
Those younger than 21 and pregnant and post-partum women through the last day of the second month following end of pregnancy are exempt from copayment requirements.
There is an annual maximum of $250 on pharmacy co-payments.
Pharmacy services coverage grid --From Partners Community Benefits. Explains pharmacy co-pays and various wrap-around scenarios.
Categories of Health Safety Net eligibility
There are three levels of Health Safety Net coverage based on income and, in some cases, assets:
- HSN Primary:
- between 0 and 150% FPL (prior to 6/23/16 was up to 200%)
- no other health insurance, and no access to "affordable" insurance.
- HSN Secondary (wrap around):
- between 0 and 150% FPL
- has other health insurance
- can use HSN for services not covered by their primary insurer
- Note: Patients on MassHealth Standard, CommonHealth, and Family Assistance/Direct Coverage are NOT eligible for HSN Secondary.
- HSN Partial:
- between 151% and 300% FPL (prior to 6/23/16 was up to 400%)
- may or may not have other health insurance
- must meet a deductible based on family income before HSN will pay for services
Back to Top
Primary Care in Hospital Clinics: Critical Access vs. Routine Care
As of January 1, 2005, individuals may only use the Health Safety Net at hospitals for primary care when an individual’s condition is so severe that it cannot be treated outside of the hospital setting (e.g., unique services, complex cases where continuity of care is critical, etc.) or there is no community health center within five miles of the patient's location. Services identified as ‘routine care,’ such as regular doctor's visits must be provided by community health centers.
Back to Top
Length of Eligibility
One's low income patient status, which is necessary to receive the Health Safety Net, is maintained for one year from the start date as determined by MassHealth. There is no limit to the number of times one may requalify.
Retroactive coverage:
- Important Note: changes as of 6/1/16
- New shorter coverage period: 10 days retroactive coverage. Hospital and community health center staff will be able to determine preumptive eligibility even in absence of all verifications to protect the application date.
- Patients eligible for ConnectorCare, have temporary HSN eligibility 10 days prior to application and 90 days after date of application to allow enrollment.
- Patients with comprehensive MassHealth used to have Free Care wrap around with 6 month retroactive coverage. Since they no longer have HSN, they lose this retro coverage.
Back to Top
Immigrants and the Health Safety Net
One does not need a Social Security number or legal status to qualify for coverage under the Health Safety Net . As long as an individual is a Massachusetts resident, can verify identity, and meets other eligibility criteria, they can receive the Health Safety Net.
Back to Top
How To Apply
MGH patients should apply through Patient Financial Services. There is a single application process for MassHealth and HSN.
Individuals are no longer able to deny other coverage options and opt for the Health Safety Net.
Back to Top
Renewals
You must report any changes that might affect your eligibility for the Health Safety Net. These include a change in family size, family income, or health insurance status.
You must also report any insurance awards or worker's compensation benefits that you get if your medical bills were the result of an accident.
"Job Update"- DOR Income Verification Process (Fall 2012):
- A new Job Update process has been designed to use DOR quarterly wage reporting data to improve income integrity for MassHealth, Commonwealth Care, and Health Safety Net members.
- Households will be selected for this process if MassHealth has their income at 300% FPL or lower AND the DOR data shows an income of 310% of FPL or higher (with some limited exceptions such as being homeless). In other words, only those for whom this discrepancy indicates that their benefits should be reduced/eliminated.
- Households selected for this process will be sent a Job Update Letter and Form containing their DOR quarterly wage data and do not need to return the Form if the information DOR has provided regarding their income is correct. If the information is incorrect, it is very important that members respond promptly. If MassHealth does not receive a response indicating that the DOR records are incorrect within 30 days, the members’ benefits and premiums will be automatically redetermined based on the DOR information. The letter will include instructions about how to notify MassHealth and the verifications requested.
- If one’s benefits/premiums are redetermined based on DOR information, MassHealth will send a notice of this redetermination. That letter will also include information on how to appeal the decision. (For source info see MGH Community News, September 2012.)
Special Renewal Program- Express Lane (Fall 2012)
Express Lane renewal is a streamlined annual review process for families meeting certain criteria who are receiving both active MassHealth, Commonwealth Care, or Healthy Safety Net benefits and Supplemental Nutrition Assistance Program (SNAP) benefits.
- Families selected for this process will receive a letter telling them that their eligibility has been reviewed electronically and, unless there are changes to report, they do not need to return the annual eligibility review form. Families should review this form carefully as future benefits will be based on the information it contains.
- If the family needs to report a change in income, disability, immigration status, or other changes that may make family members eligible for a more complete benefit, they will be instructed to complete, sign and date, and return form.
- Depending on which form they are sent, they have different lengths of time to respond. They have 45 days to return an Eligibility Review Form (ERV) or 30 days to return the Eligibility Review for Seniors and Certain People Needing Long-Term-Care Services (MER) (Source- see MGH Community News, September 2012)
Troubleshooting
Health Coverage Self-Service Hotline (MA) 888-665-9993
The state has a self-service telephone hotline that members, applicants or advocates can call to get case details on a member or applicant for MassHealth, ConnectorCare or the Health Safety Net. It is available 24/7 with the exception of Saturday, 10:00PM to Sunday, 6:00AM and has English and Spanish capacity.
Information available from the hotline:
• Case status (approved, closed, etc.)
• Key eligibility dates (i.e., next review date)
• Plan information
• Items still needed to process the case
• Examples of acceptable verifications
• Address to send outstanding verifications and forms
• Description of notices or other items recently sent by MassHealth
• Ability to request a copy of a misplaced or lost form
Advocates need the patient's social security number and date of birth to access that account.
Archive
In October 1, 2007 the Massachusetts Health Safety Net Trust Fund (HSN) has replaced the Uncompensated Care Pool ("Free Care"). One major eligibility change: those eligible for ConnectorCare (Commonwealth Care at the time) or MassHealth are no longer permitted to choose the Health Safety Net over those programs. Likewise if they are subject to premiums and do not pay them, they are no longer able to receive coverage from the HSN.
Note on the Affordable Care Act- HSN will continue after ACA implementation, though some people will now be eligible for more comprehensive coverage. See the PHS Transition Guide for details.
Link to: Health Safety Net regulations (see "Health Safety Net Eligible Services".)
HSN and Partners HealthCare Facilities
- Free Care hasn't gone away - it's been replaced by HSN. Eligibility is more limited, so there are fewer HSN patients than there were Free Care patients.
- HSN patients can access hospital, health center, and physician services in the same way that Free Care patients could. In fact, there are many HSN patients in primary care at BWH sites like Women's Health Associates, Brookside, and Southern Jamaica Plain, and at MGH Health Center sites.
- HSN patients can receive medically necessary services that are covered by MassHealth Standard. This includes non-urgent scheduled procedures.
- BWPO/MGPO policy is to provide medically necessary services to HSN patients the same way that they would provide medically necessary services to a MassHealth Standard patient.
- Some patients, such as Medicare patients, still have HSN as secondary coverage to cover services that aren't covered by their primary insurance.
-Adapted from “Serving Health Safety Net Patients: REMINDERS”, Kim Simonian, MPH, Community Benefit Programs, Partners HealthCare, November 10, 2008.
Page reviewed 3/16, revised 7/17
|
