2014 MassHealthApplication Updates SHINE Counselor Training
Topics • Role of SHINE Counselors • Overview of MassHealth program changes for Medicare population • New forms • Application for Health Coverage for Seniors and People Needing Long-Term-Care Services (SACA-2) • Application for Health Coverage and Help Paying Costs (ACA-2) • Authorized Representative Designation Form
Role of SHINE Counselors SHINE provides health benefit counseling to individuals with Medicare and their caregivers MassHealth can provide significant savings and comprehensive supplemental coverage for Medicare beneficiaries Therefore, it is a SHINE counselor’s responsibility to screen and educate Medicare beneficiaries on MassHealth programs When necessary, a SHINE counselor may help a Medicare beneficiary apply for MassHealth
Available Assistance with MassHealth Applications Spouse, adult child, other responsible relative MassHealth Certified Application Counselors and Navigators ASAP case managers, if a client COA outreach workers, if a client Long term care facility staff or contracted “Medicaid Specialists” SHINE Counselors
Recent MassHealth/Connector Program Changes Significant changes to MassHealth and Connector programs went into effect January 2014 There are new MassHealth coverage types, benefits through the Connector, eligibility requirements, and procedures The Good News: many of these changes do not impact our clients—Medicare beneficiaries
Changes that SHINE Counselors Need to Know • New MassHealth applications for applicants of all ages (ACA-2 and SACA-2 forms) • New Authorized Representative Designation (ARD) form replaces Eligibility Representative Designation (ERD) form • Medicare beneficiaries will not qualify for plans through the Connector or new premium tax credits • Two exceptions: • Beneficiaries paying for Part A • Beneficiaries receiving coverage through a small employer that is participating in a Connector program
SACA-2 …or the Application for Health Coverage for Seniors and People Needing Long-Term-Care Services Replaces the Senior Medical Benefit Request (SMBR) form To be used by applicants 65+ or applicants of any age applying for Long Term Care MassHealth
SACA-2 • Since MassHealth for individuals 65+ is largely unchanged, many of the questions from the SMBR remain • Some questions have been added to be used in determining eligibility for new programs through the Connector, including premium tax credits. • With some rare exceptions, Medicare beneficiaries are not eligible for these new programs.
Sample A To be used to familiarize yourself with the new application Notations have been added by SHINE Yellow-highlighted text are new questions Tips for counselors are in red boxes
Sample B You meet with George, 72, and his wife Louise, 78. They both have Medicare but George is finding it difficult to get and pay for services he needs for Louise. He tells you his dear “Weezy” has advanced dementia and needs around-the-clock care, which is becoming expensive. He looked into MassHealth in the past but does not believe they would be eligible because of their considerable assets, which includes a deluxe apartment.
Sample B Their income and assets are: George • $2,500/month from Social Security • $800/month from a pension • Whole life insurance policy with $250,000 face value and $125,000 cash surrender value Louise • $1,200/month from Social Security Joint assets • Checking account - $1,500 • Savings account - $80,000 • A deluxe apartment worth $500,000 You explain to George that Louise may qualify for MassHealth through the Frail Elder Waiver program, which will not count George’s income and any assets that are transferred into George’s name only.