Bill > H997

This bill establishes criteria for MassHealth hardship waivers, which are exceptions to ineligibility periods for nursing facility residents. MassHealth is the Massachusetts Medicaid program that provides health care coverage to eligible low-income individuals and families. The bill amends Chapter 118E of the General Laws to create Section 28A, which outlines procedures for determining if a nursing facility resident faces undue hardship due to a period of ineligibility, meaning they would suffer serious deprivation or harm if the ineligibility period were enforced. This includes providing written notice of the hardship exception, a timely process for decisions, and an appeal opportunity, with residents having 90 days after a final decision to request a waiver. A rebuttable presumption of eligibility for a waiver exists if the resident demonstrates insufficient resources for necessities, reasonable attempts to recover transferred assets or receive compensation, no less costly alternatives to institutional care, and that the ineligibility would pose a risk of serious deprivation, not just an inconvenience. Importantly, a nursing facility does not need to intend to discharge a resident for nonpayment for a hardship waiver to be granted, and the division will create regulations to implement these criteria.