According to the CMS letter, MassHealth’s current policy does not comply with federal law. Up until recently, MassHealth practice has been to only allow for a PPA reduction where the applicant has incurred additional medical expenses following approval. For example, if a MassHealth recipient requires dental work following approval which is not covered by MassHealth, the individual may submit the bill to the appropriate MassHealth Enrollment Center (MEC) and request a reduction in the PPA for the coming months so that the applicant can use his or her income until the bill is paid in full. Once the bill is paid, MassHealth may reinstate the PPA. As the CMS letter indicates, MassHealth must begin applying this same process to medical bills preceding eligibility as well.
The letter does not specify a time limit for how far prior to eligibility an individual may submit bills for a PPA reduction. However, CMS suggests that the MassHealth agency may place a “reasonable” limitation, such as three months, on the medical bills which can be considered. The letter also indicates that MassHealth may wish to consider eliminating a PPA reduction where the outstanding bills result from a disqualifying transfer. In either case, the letter requires that any limitation may only be made by amendment to the State Plan.
Despite the inevitable difficulties associated with implementing the new policy at the local MECs, we are hopeful that caseworkers will soon become familiar with the new practice as more cases are submitted requesting a PPA reduction for pre-approval medical expenses. The new policy may prove an incredibly useful tool in covering nursing home bills where an application was not submitted in time for retroactive approval or where an applicant’s assets exceed the program limit for a short time following the requested approval date.
As always, if you have questions or comments please feel free to contact one of the attorneys at Cohen & Oalican, LLP.
