130 CMR, § 522.001 - Massachusetts Insurance Connection for Individuals with AIDS or HIV (Closed to New Applicants)
(A)
Introduction. The Massachusetts Insurance Connection
(MIC) is a health insurance buy-in program administered by the MassHealth
agency for individuals with Acquired Immune Deficiency Syndrome (AIDS) or human
immunodeficiency virus (HIV). MIC is closed to new applicants effective January
1, 2020. Program participants may continue to receive benefits through MIC for
as long as they meet the requirements of 130 CMR 522.001(B).
(B)
Eligibility
Requirements. The MassHealth agency may pay the monthly private
and group health insurance premiums of a program participant (and his or her
spouse and dependent children, provided that the program participant
(1) was enrolled in the MIC program as of
December 31, 2019, and remains continuously enrolled in the MIC program
(continuous enrollment ends when a program participant has not been enrolled in
the MIC program for six months);
(2) had a health insurance policy (group or
private) before becoming eligible for the MIC program (individuals who elect to
continue employer-based group health insurance are subject to the provisions of
the Omnibus Budget Reconciliation Act of 1990 (OBRA) and the Consolidated
Omnibus Budget Reconciliation Act of 1985 (COBRA), P.L. 99-272) that
(a) has comprehensive coverage, as determined
by the MassHealth agency on an individual basis; and
(b) requires premium payments that do not
exceed the average monthly cost incurred by the MassHealth agency for the care
of an individual with AIDS or HIV;
(3) has a diagnosis of AIDS or HIV;
(4) applies for and meets the Social Security
Administration's definition of disability for AIDS or HIV;
(5) is a resident of Massachusetts;
(6) in conjunction with his or her spouse and
dependent children, has a gross annual income that does not exceed 300% of the
annualized federal poverty level income standard for a household of that size;
and
(7) is not eligible for a
MassHealth coverage type that provides or pays for comprehensive
benefits.
(C)
Verifications. Applicants must have submitted the
following verifications to the MIC program coordinator within 45 days of the
receipt of the application by the MassHealth agency:
(1) a written statement of a diagnosis of
AIDS or HIV by the examining licensed physician;
(2) documentation of receipt of social
security disability benefits or SSI; and
(3) documentation of gross annual
income.
(D)
Redetermination of Eligibility. The MassHealth agency
completes a redetermination of eligibility for each program participant on an
annual basis, or as needed.
(E)
Termination of Benefits.
(1) When a program participant no longer
meets one or more of the conditions in 130 CMR 522.001(B), the MassHealth
agency terminates premium payments for that program participant effective on
the next premium payment due date. However, the following exceptions apply:
(a) in the event of the death of a qualified
individual who has coverage under a family plan, payment for the continuation
of the existing plan will not exceed a period of three months following his or
her death; and
(b) if a qualified
individual relocates to another state, he or she will be afforded one
additional premium payment after relocation to cover the transition
period.
(2) The
MassHealth agency sends written notice to program participants of the
termination of premium payments, the reason for the termination, and the
individual's right to appeal such termination in accordance with the provisions
of 130 CMR 610.000: MassHealth: Fair Hearing Rules.
Notes
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