Transcript Health Law Advocates - Mass Legal Services

MLRI: Health Care Access Programs
The Commonwealth Care Health Insurance
Program and Reintegrating Our
Legal Immigrants
Lorianne M. Sainsbury-Wong
Litigation Director
Health Law Advocates
[email protected]
April 4, 2012
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Why Must Massachusetts Residents Have
Health Insurance?
 In 2006 a landmark state health reform law
required nearly every adult state resident to have
health insurance so long as it is affordable.
 This law is also known as “Chapter 58.” It is our
state’s health care reform law, which was a model
for federal law.
 Commonwealth Care was created by Ch. 58 to help
adults with income under 300% of the poverty
level afford health insurance.
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The State’s Health Care Reform Law
 The law created the Commonwealth Care Health Insurance Program
(Commonwealth Care), which provides sliding scale premium subsidies
for low and moderate income residents who have no access to health
insurance.
 Commonwealth Care is not Medicaid (MassHealth).
G.L. c.118 H
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What Is Commonwealth Care?
 The Commonwealth Care Health Insurance Program
(Commonwealth Care) is run by the Health Insurance Connector
Authority.
 It uses the same application form as MassHealth
 The Office of Medicaid (MassHealth) makes the initial decision
about whether someone is eligible for MassHealth or Commonwealth
Care
 The benefits of Commonwealth Care include regular check-ups,
treatment when you are sick or injured, prescriptions at your local
pharmacy, vision care, mental health or substance abuse treatment,
and, for some members, a limited amount of dental care.
 Commonwealth Care plans are offered by Boston Medical Center
(BMC) Health Net Plan, Fallon Community Health Plan,
Neighborhood Health Plan, Network Health, and Celticare.
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Who Is Eligible for Commonwealth
Care?
 Massachusetts residents,
 US citizens or legal immigrants,
 With gross family income under
300% of the poverty level,
 Not eligible for MassHealth, Medicare
or CMSP, &
 Who are uninsured & without access
to insurance
Who Is Considered Uninsured in
Commonwealth Care?
UNINSURED:
 You do not have health insurance
 You only have insurance through COBRA or mini-COBRA
 You or a family member’s current employer has not provided
health insurance coverage in the last six months that covers at
least 20% of the premiums for a family plan or at least 33% of
an individual plan.
 You are in a waiting period prior to becoming
eligible under an employer-provided health benefit plan
 You are a part-time employee who does not work enough
hours to be eligible for health benefits through your job.
See Commonwealth Care regulations 956 CMR 3.09; M.G.L.
c118H, § 3(a)
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Who is considered to have access to insurance
under Commonwealth Care?
Any person who has or is eligible for, even if not enrolled in:
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MassHealth (except Limited)
Children's Medical Security Plan
Medicare
TRICARE
Student Health Insurance Program
MA Division of Unemployment Assistance’s Medical Security Program
Employer-subsidized insurance (minimum 33%/20% of costs of
individual/family coverage)
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The Commonwealth Care Exceptions Process
• An exceptions form is a notice that applicants or enrolled members
receive when they report that their current employer offered them
insurance within the last six months. Ordinarily, a person who is eligible
for employer sponsored insurance is not eligible for
Commonwealth Care.
• The exceptions form provides the opportunity to identify certain
exceptions the member/applicant might meet to qualify them for
Commonwealth Care coverage (e.g., they are in a waiting period
for their employer’s health insurance)
See Q & A 92 in MLRI MassHealth Guide for more details
An exceptions form can be triggered by:
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1. The application process (MBR)
2. Updates to case (self reported or DOR matching)
3. The annual eligibility review (ERV) process or insurance investigation
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Enrolling in Commonwealth Care
 Benefits begin on the 1st of the month
after someone was found eligible &
enrolls
 In order to enroll
 Must select a managed care plan by 25th
of the month
 If a premium is due, first month’s
premium must be received by 25th of the
month
Monthly premiums
 No premium for those under 100% of
poverty (Plan Type 1)
 Option to pay no premium for those
between 100-150% of poverty (Plan Type
2A)
 Premiums for all those over 150% of
poverty (Plan Types 2B & 3)
 Minimum $39 (150-200%); $77 (200-250%);
$116 (250-300%)
 Hardship waivers possible
Cost sharing
 No deductibles or co-insurance
 Nominal copays same as MassHealth
for Plan Type 1 (under 100% fpl)
 Copays less than private insurance
(Plan Type 2 (100-200% fpl)
 Copays similar to private insurance
(200-300% fpl)
 See Table 9 Apx B in Guide
The Legal Immigrant Class Action Lawsuit
 From 2006-2009 all legal immigrants were eligible for
Commonwealth Care
 In 2009, in order to save money, the legislature changed the
law so that only “qualified” immigrants were eligible
 The 2009 law also created a lower cost program for legal
immigrants who lost full benefits in 2009 that was called
Commonwealth Care Bridge.
 Legal immigrants filed a class action lawsuit challenging
the 2009 law as unconstitutional.
 Finch v. Commonwealth Health Ins. Connector Auth.,
461 Mass. 232 (2012)
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Legal Immigrants Cannot Be Unconstitutionally
Discriminated Against by the State
“In light of their particularly vulnerable status,
it thus remains necessary to exercise heightened
vigilance to ensure that the full panoply of
constitutional protections are afforded to the
Commonwealth’s resident aliens.”
Finch v. Commonwealth Health Ins. Connector Auth., 459 Mass. 655, 675 (2011) (declining to
apply the rational basis review of aliens excluded from political functions to the plaintiff class
of legal immigrants).
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Finch v. Commonwealth Health Ins. Connector Auth.,
461 Mass. 232 (2012)
Supreme Judicial Court of Massachusetts,
Suffolk.
Dorothy Ann FINCH & others FN1
FN1. Roxanne S. Prince and Jane Does Nos. 1 and 2 (pseudonyms), individually and on behalf of all similarly situated persons.
v.
COMMONWEALTH HEALTH INSURANCE CONNECTOR AUTHORITY & others.FN2
FN2. The executive director of Commonwealth Health Insurance Connector Authority and the Commonwealth, as an
intervener.
Background: Lawful resident aliens filed class action in the county court challenging, under equal protection
principles of state constitution, a legislative appropriation excluding from eligibility for state's health
insurance premium assistance program aliens who could not receive federally-funded benefits under the
federal Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA). A single
justice of the Supreme Judicial Court, Suffolk County, Cordy, J., reserved and reported questions. The
Supreme Judicial Court, 459 Mass. 655, 946 N.E.2d 1262, determined that appropriation discriminated on the
basis of alienage and national origin and thus should be subjected to strict scrutiny, and remanded. On
remand, after aliens moved for partial summary judgment, the single justice again reported the matter to the
full court.
Holding: The Supreme Judicial Court, Cordy, J., held that appropriation violated equal protection.
Remanded with instructions.
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Finch v. Commonwealth Health Ins. Connector Auth.,
461 Mass. 232 (2012)
“Conclusion. Section 31 (a ) cannot pass strict scrutiny. The discrimination against legal immigrants
that its limiting language embodies violates their rights to equal protection under the Massachusetts
Constitution.
We recognize that our decision will impose a significant financial burden on the Commonwealth. See
Finch, supra at 675, 946 N.E.2d 1262. Nonetheless, “the fiscal consequences of any ... judgment on
the merits cannot be permitted to intrude on consideration of the case before us.... ‘[M]inorities rely
on the independence of the courts to secure their constitutional rights against incursions of the
majority, operating through the political branches of government.’ ” Id., quoting Commonwealth v.
O'Neal, 369 Mass. 242, 271, 339 N.E.2d 676 (1975) (Tauro, C.J., concurring). If the plaintiffs' right
to equal protection of the laws has been violated by the enactment of § 31, then it is our duty to say
so.
The case is remanded to the single justice, with instructions to enter partial summary judgment in
favor of the plaintiffs.
So ordered.”
Finch v. Commonwealth Health Ins. Connector Auth., 461 Mass. 232, 249-50 (2012)
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Legal Immigrants Win in a Class Action Lawsuit
 The Massachusetts Supreme Judicial Court paved the way for
approximately 40,400 low-income legal immigrants to receive
comprehensive, state-subsidized health insurance under Commonwealth
Care.
 The Court reaffirmed the Commonwealth’s commitment to near
universal health insurance.
 The Court clarified that legal immigrants are a protected class under the
state Constitution
 The Court emphasized that in Massachusetts, the standard that the state
courts use to judge the validity of a law that harms a suspect class, such
as race or legal immigrants, is “strict.” This is the highest level of
review that a court can impose when reviewing a state law.
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Legal Immigrants Rejoin Commonwealth Care
Thanks to the class action lawsuit filed by Health Law Advocates and the many amici briefs filed by heath
care reform organizations, such as GBLS, Health Care For All, Massachusetts Law Reform Institute, and
Massachusetts Immigration and Refugee Advocacy Coalition.
March 1, 2012:
12,845 legal immigrants have been restored to Commonwealth Care!
These persons were removed from Commonwealth Care in September 2009 and placed in the Commonwealth Care
Bridge Program (Bridge). Bridge no longer exits – thanks to Massachusetts advocates. Bridge had a limited provider
network, fewer benefits, and cost legal immigrants more money.
May 1, 2012:
25,884 legal immigrants will be eligible to enroll in Commonwealth Care!
The number of legal immigrants is an estimate and may be greater than above because applications are processed daily.
The Connector will mail out approval letters on March 26, 2012, April 2, 2012, and April 9, 2012.
Those persons on the wait list the longest will receive their Commonwealth Care approval notices first..
These legal immigrants can select a Commonwealth Care plan and enroll in coverage:
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www.MAhealthconnector.org They can sign up for internet access to their account and
create a login
Call Commonwealth Care Customer Service at 1-877-623-6765
Mail their enrollment packets to Commonwealth Care Member Service Center, 133
Portland Street, 1st Floor, Boston MA 02114-1707
Fax at 1-877-623-2155
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The State’s Health Care Reform Law is Once
Again Achieving Near Universal Coverage
 Thanks to Massachusetts Constitution and strict judicial scrutiny, legal
immigrants throughout Massachusetts are reintegrated into the state
insurance that they were wrongfully denied.
 Massachusetts has reaffirmed its commitment to equality under our
Constitution, and our courts’ strict review of state discrimination against
legal immigrants really means ‘strict.’
 The promise of near universal health insurance made to residents in
2006 is restored.
 The Commonwealth of Massachusetts created a landmark heath care
reform law that serves as a model for other states and the Federal
government.
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In 2014, under the federal Affordable Care Act, legal immigrants or personas legally
residing will be eligible for Federal subsidies to support the purchase of health
insurance under the exchanges established under the federal law.
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You can help
 Look out for the approx. 26,000 legal immigrants & make
sure they pick a plan, pay premium, if needed, and enroll!
 They will lose access to Health Safety Net 90 days after
March-April notices go out if they don’t enroll
 If immigrants miss April 25th deadline, it’s too late for May
1st but they can still enroll for later months
 For example, enroll by May 25th for coverage to start June 1st
 A legal immigrant is not enrolled by June 1st will not be
able to participate in the Open Enrollment for
Commonwealth Care health plans