2014 MassHealth Application Updates SHINE Counselor

2014 MassHealth
Application Updates
SHINE Counselor Training
• 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
• 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
• 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
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
• …or the Application for Health Coverage for
Seniors and People Needing Long-Term-Care
• Replaces the Senior Medical Benefit Request
(SMBR) form
• To be used by applicants 65+ or applicants of
any age applying for Long Term Care
• 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
– With some rare exceptions, Medicare
beneficiaries are not eligible for these new
Sample A
• To be used to familiarize yourself with the new
• 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-theclock 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
Sample B
Their income and assets are:
$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
$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.
George is so happy he jumps up
and starts to dance!

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