Some examples of mandated "CHURN"

Massachusetts has several regions that cater to the tourist trade, hence, many jobs are seasonal. The typical tourist season runs from mid-April through October. During the winter, seasonal workers may collect unemployment benefits for up to 26 weeks. 

While seasonal employees are working, they may be eligible for Commonwealth Care. However, once they begin to collect unemployment, they are expected to enroll in the Medical Security Plan (MSP) that is offered with unemployment benefits and are no longer eligible for Commonwealth Care because they have access to other insurance. MSP requires a termination letter from Commonwealth Care before it can consider an application even though it knows the state denies Commonwealth Care to anyone collecting unemployment.

So, let’s say you mail in an MSP application the day after you open your unemployment claim because you know you are going to lose your Commonwealth Care eligibility. MSP will send you a denial stating that you still have Commonwealth Care. MSP requires a termination letter from Commonwealth Care before it can consider an application even though it knows the state denies Commonwealth Care to anyone collecting unemployment. So you contact your plan (provider), Commonwealth Care customer service and MassHealth Enrollment Center for this letter to be provided to MSP. If everything goes smoothly, you will wait up to at least 4 weeks for MSP to reprocess your application. (We heard in May 2009 that the wait time had increased to at least 8 weeks, probably due to the vast number of layoffs.) Although the MSP coverage is retroactive to the opening of your claim, you won’t have a card to receive services until the application has been processed. In the meantime, your Commonwealth Care has been terminated, and you are left holding the bag - a coverage gap during which you may be able to get partial Health Safety Net. The good news is that you may be in a “safety zone” with regard to penalties. 

When you are back on the job the following season, you have work for two weeks so you can supply MassHealth with the required number of pay stubs in order to reapply for Commonwealth Care at which point you will wait two more weeks for this change to be processed. But, alas, Commonwealth Care coverage starts on the first day of the month after your first premium check has been received, not the date of the application, and you may have to wait up to 8 weeks after losing MSP coverage to be re-enrolled in Commonwealth Care. 

A seasonal worker may have to go through this process up to 4 times a year if they have to re-open an old unemployment claim until their benefits have been exhausted and then open a new claim. Some are willing to pay their Commonwealth Care premium while on unemployment to avoid the gaps in coverage, but the Connector won’t allow this. Due to these gaps there is no continuum of care including appointments, procedures and access to prescription medication.

We read that an outreach specialist reported having residents eligible for MSP erroneously receiving letters stating they are eligible for Commonwealth Care which leaves the residents thinking they don’t have to apply for MSP. If these residents receive medical services before the mistake has been noticed and fixed, will they be responsible for uncovered medical expenses?

If you were a full-time employee and have been laid off and cannot afford Cobra or MSP has sent you an over-income denial letter, you can apply for Commonwealth Care if your income is at or below 300% FPL because it uses different formulas to determine income. However, you must send a copy of your MSP denial notice to the Connector before you can apply and then wait several weeks for an “exceptions” letter during which time you will be uninsured but not penalized because you are in a “safe-zone.” But once you receive that letter, you have 30 days to sign up for insurance.

Here’s another kicker. If you are now in Commonwealth Care after having gone through the process described above and then get an extension of your unemployment benefits, you are no longer eligible for Commonwealth Care because you have access, once again, to MSP. So, you have to start all over again.

If your unemployment income puts you into a bracket for which there is no “affordable” insurance, you can request a waiver, and you won’t be penalized but will be without insurance.

There are also residents who are enrolled in MSP and will receive extensions to their unemployment benefits. However, when their original unemployment claim ends, they lose MSP coverage and become eligible for Commonwealth Care as of the first of the following month. However, once they get the extension of unemployment benefits, they lose their Commonwealth Care eligibility and must wait for MSP all over again.

As seasonal workers already know, after your MSP coverage ends, there is no quick way to reinstate your previous membership in Commonwealth Care. MSP can end during any week of the month depending on when your unemployment ends, but Commonwealth Care coverage does not begin until the first of the month following enrollment. Also, in a monthly premium is required, if you have not paid the premium by the 25th of the month of enrollment, you must wait yet another month for coverage to begin so you, too, must be prepared for a gap in coverage when switching from MSP to Commonwealth Care - and back again.

Both unemployed people and outreach workers continue to have difficulties interfacing with MSP. For the most part, this is due to the time spent waiting for the application to be processed which can cause much anxiety to some folks. One outreach worker reported a resident whose wife was hospitalized while the application was pending. It is often impossible to get through to an MSP representative over the phone. 

The demands upon outreach workers are higher than ever while the resources available are limited. As another outreach worker put it: "It’s worse than I’ve ever seen, and we have to be more creative."

Other employees whose hours have been cut no longer have access to affordable insurance because they are participating in a workshare program with unemployment instead of receiving traditional benefits. They are not eligible for MSP or the new federal COBRA subsidy.