Did you know? Community Research Initiative is now AccessHealth MA!

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Did you know? Community Research Initiative is now AccessHealth MA!

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Frequently Asked Questions

AccessHealth MA has many resources and helpful information for clients, case managers, navigators and any other individuals who help those living with HIV access health insurance and drug payment assistance, listed below.  

If you would like to be added to our email list to be notified:

Questions? 

If you have any questions that are not answered here, please contact our HDAP Team.

I’m very appreciative of everything you and your coworkers have done for us in such a short time. It is rare to come across someone in a program such as yours that cares. It’s unheard of to find that everyone does. Thank you.

AccessHealth MA CHII Client

HDAP FAQs

To be eligible for HDAP your annual gross income must not exceed 500 percent of the federal poverty level (500% FPL). $67,950 as of January 12, 2022, with an allowance of $4,720 per dependent.

• Include BOTH the applicant and legal guardians name on the application
• HDAP coverage will be in the minor’s name

Examples of documents that are acceptable forms of proof of MA residency are:

  • A copy of a recent utility bill
  • A copy of the applicant’s valid driver’s license/State ID address written on the back is not acceptable proof
  • A valid lease
  • A signed letter from the applicant’s case manager, if none of the above are available (see instructions)

Note: The address on proof of residence document submitted MUST be the client’s current address and MUST match the address on the application.

No, PO boxes cannot be used for proof of MA residence.

A case manager letter, stating the client does not have a permanent address is acceptable. The letter should provide the MA city and zip code in which the client generally resides. It should also be signed dated and on the case managers institutions letter head.

Yes, we can send mail to a PO box if this is what the client prefers and is listed in the mailing address section of the HDAP application.

Yes, the client can indicate on the application that they prefer to have their HDAP application mail sent to their case manager.

Yes, they can. Immigrations status does not affect eligibility for the HDAP program. Clients without a valid Social Security numbers can enter 999-99-9999 on the Social Security number portion of the application.

Note: HDAP does not share information with immigration officials or any other unauthorized government agency.

Yes, the client’s date of birth needs to be included each time an applicant submits enrollment information.

At least ONE of the following:

  • Two recent paystubs (Please indicate on paystub the frequency of pay period, i.e., weekly, bi-weekly or monthly)
  • Most recent federal tax return (1040 form and schedules) for self-employed applicants

A zero-income letter from a case manager is acceptable as proof that the client has no income. The letter should state how the client is supporting themselves and should signed, dated, and on the case managers institutions letter head.

Some acceptable forms of proof of income include:

  • Unemployment statement
  • TAFDC/EAEDC benefit letter
  • Social Security benefit letter

Yes, with the exception of the case manager portion. If you do not have a case manager, you may leave this section blank.

The applicant’s medical provider/clinician should complete, sign, and date this section.

Co-Pay Information

HDAP will pay for most FDA-approved medications that are covered by your primary insurance. Please refer to our exclusion list for medications that are not covered by HDAP (subject to change).

HDAP requires this section to be completed to provide the pharmacy with coverage information and for reimbursement purposes. This also gives us permission to speak with the preferred pharmacy should any issues or questions arise.

Clients may change pharmacies at any time during their active enrollment with HDAP; however, they must notify HDAP by phone or in writing of this change.

Yes, only for the following reasons:

  • The insurance requires that they use mail order; or
  • A medication is not available at the preferred pharmacy

No, HDAP is only able to pay the pharmacy directly. HDAP does not provide direct reimbursement to clients.

Once a complete application is received, it may take up to two weeks to be processed. Please note, except in special cases, applications are processed in the order they are received. Clients in urgent need of medication should contact HDAP enrollment after an application has been submitted to request expedited processing.

Client Agreement Statement/Certification Statement

Yes, every applicant must read the client agreement/certification statement section and then sign and date.

If the application is left unsigned, it will be rejected.

You and all of the {AccessHealth MA} staff make our jobs so much easier, and you make such a difference in clients’ lives

Case Manager

Health Insurance: Special Considerations for Immigrants FAQs

Undocumented clients can apply for insurance by submitting a paper application to MassHealth via fax or mail. These methods may be preferable because clients can submit documents with the application. The MassHealth paper application asks if applicants have a Social Security number. Clients may select “No” and then select “Noncitizen exception.”

Clients who are undocumented can also apply for insurance over the phone by calling MassHealth customer service at 1.800.841.2900. When asked for a Social Security number, clients can respond by stating that they do not have one. After the call, clients will likely need to submit documents to MassHealth (e.g., proof of residency, proof of income) within 90 days in order to complete their application.

In order to be eligible for insurance through the Health Connector, clients must be lawfully present with a valid Social Security number. Therefore, clients who are undocumented are not eligible to apply for insurance through the Health Connector.

Resource: https://www.mass.gov/lists/applications-to-become-a-masshealth-member

HSN provides coverage for certain medical services provided at specific locations that are HSN sites. These sites include most community health centers and acute care hospitals.
HSN covers prescription drugs, but only at designated HSN pharmacies that are usually linked to the prescriber’s HSN site. HSN covers routine HIV care and HIV treatment medications, and many clients’ needs are met with HSN and MassHealth Limited coverage.

Some clients may require care that is not covered by HSN (e.g., specialist visits). For these clients, please reach out to the BRIDGE team for assistance.

MassHealth Limited covers emergency services only.

HSN and MassHealth Limited are not insurance plans and do not qualify as health insurance for tax purposes.

Resources:
https://www.mass.gov/service-details/health-safety-net-for-patients
https://www.mass.gov/service-details/masshealth-coverage-types-for-individuals-and-families-including-people-with-disabilities

Yes. The Health Connector and MassHealth will need to know the details of your client’s immigration status in order to determine their eligibility for subsidized insurance plans, such as MassHealth or ConnectorCare plans. Details of a client’s immigration status (e.g., identifying numbers or codes) will be found on their immigration document(s). See resources linked below for more information on how to interpret immigration documents.

Resources:
https://betterhealthconnector.com/immigration-document-types
https://save.uscis.gov/web/media/resourcesContents/EAD_Code_Table.pdf
https://www.masslegalservices.org/system/files/library/NILC%20Table%20%20Key%20to%20Codes.pdf

The BRIDGE team recommends that you refer your client to an immigration specialist to verify your client’s immigration status. See resources linked below for a statewide referral list.

Resources:
https://www.masslegalservices.org/content/statewide-referral-list-immigration-providers
https://www.immigrationadvocates.org/nonprofit/legaldirectory/search?state=MA

See resource linked below for a document that lists which types of insurance coverage Massachusetts residents are eligible for based on their immigration status.

Clients who are eligible to apply for insurance through the Health Connector (see Table 2 in resource below) must apply through the Health Connector to receive premium assistance through the CHII program.

Depending on a client’s immigration status, they may be eligible for comprehensive MassHealth coverage, or they may only be eligible for subsidized insurance coverage through the Health Connector because they have not yet met the MassHealth five-year bar rule.

Other eligibility factors, such as income, play an important role in determining your client’s eligibility for subsidized health insurance, in addition to their immigration status.

Resource:
https://www.masslegalservices.org/content/understanding-immigrants-eligibility-masshealth-other-subsidized-coverage-2020-0

The 2019 Public Charge Final Rule is no longer in effect. The 1999 Field Guidance is the current public charge policy that guides immigration officials in their review of applications for lawful permanent residence (green card) or for entry to the US. The policy allows officials to review or “test” if a person is likely to become a public charge, which is a person who is primarily dependent on the government for support, when they apply for a green card or to enter the US.

The use of most public benefits, such as health (including MassHealth or HDAP/CHII services), nutritional, and housing assistance programs, are not considered in a public charge test. Only the following benefits are considered in a public charge test: Federal or state-based cash assistance programs (e.g., SSI, TANF, EAEDC) and long-term institutional care covered at government expense (including MassHealth Long-Term Care and Frail Elder Waiver).

See resource links below for more details you can share with clients on this topic. If your client is concerned about a public charge test, we recommend referring your client to seek immigration legal advice.

Resources:
https://www.mass.gov/info-details/information-about-the-public-charge-rule-and-how-it-may-impact-you

Home Page


Protecting Immigrant Families – The ABCs of Public Charge
https://www.uscis.gov/green-card/green-card-processes-and-procedures/public-charge
https://www.masslegalservices.org/content/statewide-referral-list-immigration-providers/

Yes. The Massachusetts Law Reform Institute has created a document with information about these immigrants and their potential eligibility for health coverage via MassHealth.

Resources:
https://www.masslegalservices.org/content/health-benefits-newly-arriving-afghans
https://www.masslegalservices.org/content/update-haitian-entrants-nov-2021

Yes. See resources below for a directory of programs and services available through the MA Office for Refugees and Immigrants and additional links to important organizations’ websites.

Resources:
https://www.mass.gov/service-details/list-of-ori-programs-and-services
National Immigration Legal Services Directory – Massachusetts
MA Immigrant and Refugee Advocacy Coalition
National Immigration Law Center
Immigrant Legal Resource Center

Did you know?

NOTE:  CHII can pay monthly insurance premiums on behalf of eligible HDAP clients 

  1. ConnectorCare plans
    • Eligible clients have an individual or family income that is less than or equal to 300% of the Federal Poverty Level 
    • Three plan levels: Types 1, 2, or 3 
    • Subsidized plans with Advanced Premium Tax Credits (APTCs) 
    • Plans have copays, but no deductible 
    • CHII can pay monthly premiums for ConnectorCare plans 
  1. Qualified Health Plans (QHPs) also known as Health Connector Plans
    • Eligible clients have an individual or family income greater than 300% of the Federal Poverty Level 
    • Four “coin level” plans: Bronze, Silver, Gold, or Platinum 
    • Plans may be subsidized and include APTCs (depending on income) 
    • Plans have copays, and may have a deductible 
    • The Platinum level plans do not have deductibles and have the least amount of out-of-pocket expenses 
    • CHII can pay monthly premiums for Platinum-level plans for clients who do not qualify for ConnectorCare level plans 

NOTE:  Changes made during the Open Enrollment Period will take effect January 1, 2019 

During the Medicare Open Enrollment Period, beneficiaries can: 

  • Do nothing and their Medicare coverage   “should renew on the 1st of the year 
  • Enroll in, change, or leave their Medicare Part D plan (prescription drug coverage) 
  • Switch from Original Medicare (Parts A & B) to a Medicare Advantage plan (Part C, combining Parts A, B, & D) 
  • And should enroll in a Part D plan to maintain Medicare drug coverage 
  • Change from one Medicare Advantage plan to another 
  • Apply for a Medicare Supplemental (“Medigap”) plan, or change from one Medigap plan to another (members may enroll year-round; some limitations may apply) 

A great way to enroll in a new plan is to go to Medicare’s website at www.medicare.gov. Clients can use this website to search and compare plans available in their area and create an account to enroll in a plan online.  Another way to enroll in a new plan is to call Medicare at 1.800.633.4227. 

Clients may want to contact The SHINE Program at 1.800.243.4636 (press option 3) to discuss their health insurance options before enrolling in a plan. SHINE (Serving the Health Insurance Needs of Everyone) is a state health insurance assistance program that provides free health insurance information and counseling assistance to Massachusetts residents with Medicare and their families. 

NOTE: Medicare members enrolled in a Medicare Part D or Advantage plan should have received an “Annual Notice of Change” in September alerting them to any changes in their premium, copays, drug formulary, or pharmacy network. 

 

HDAP’s CHII program can pay the monthly insurance premiums for Medicare Part D plans and Medicare Advantage plans that include prescription drug coverage for active HDAP clients. 

Please contact CHII for more information

CHII can help pay for the following:
  • Private health insurance premiums 
  • Insurance premiums through the Massachusetts Health Connector
  • MassHealth premiums  
  • Medicare Part B, C, and D premiums 
  • COBRA premiums
  • Employee premium deductions 
  • Self-employed private insurance premiums 

CHII enrollees should send their premium statements to HDAP/CHII every month. A client must be active in HDAP in order to receive CHII assistance for their insurance premiums. 

Please contact CHII for more information

Faxing multiple HDAP applications as one complete faxed document creates difficulty for HDAP staff and slows down our approval process. 

Please:   

  • Send HDAP application faxes to 617.502.1703 
  • Include a cover sheet with any documents you fax 
  • Fax one complete application at a time 
  • Fax applications and other documents only once 
  • Separately fax any additional documents that are unrelated to the client’s HDAP application (e.g. Advanced Premium Tax Credit [APTC] related tax documents) 

Please be aware that it can take between 48-72 hours before a faxed document displays in our screening system where HDAP staff can view it. 

If you are concerned that a fax may have not gone through or been received by HDAP, please call HDAP 48-72 hours after the fax was sent to confirm it was received.  

We highly recommend that you retain a copy of the application and all documents faxed to HDAP including the fax confirmation page with the date, time, and number of pages in your fax. This information can be used to facilitate communication with HDAP regarding your documents. 

For URGENT HDAP coverage requests, please contact HDAP at 617.502.1700 after the fax has been sent and inform the HDAP staff member of the date, time, and number of pages you have faxed for URGENT processing. In addition, please include on your fax cover page that this document needs URGENT processing and the reason why (e.g. out of medications, newly diagnosed, etc.).  

If you need an application or supporting document to be expedited through this process, please contact an HDAP staff member at 617.502.1700 with the details of the fax (including the date, time and number of pages in the fax) and request that this document be expedited. HDAP staff will determine whether we are able to expedite an application, a supporting document, or a CHII payment request on a case-by-case basis. 

Contact HDAP with any questions

By following the steps below, you may help to speed up your clients’ eligibility determination process: 

  • Include language requesting that your client’s eligibility determination be “EXPEDITED FOR MEDICAL NECESSITY” on the MassHealth paper application or on the fax cover page accompanying the application. 
  • Contact MassHealth approximately 2-4 weeks after the application has been submitted if your client has not received a MassHealth determination or a request for additional information. This call provides another opportunity to request that the determination be EXPEDITED FOR MEDICAL NECESSITY. 
  • Remind your clients that it is important to open their mail and follow up on any requests for information which are time-sensitive. Failure to submit additional information in time may result in an application review being canceled and a client needing to re-submit a new application. 
  • Place a follow-up call to MassHealth with your client approximately 1-2 weeks after any additional documents are submitted to confirm that the documents were received and are being processed. 
  • If your client has not received a determination letter within 6-8 weeks from the initial date of application submission, contact MassHealth with your client to follow-up on their application status. 

Please remember that HDAP clients who do not have active MassHealth or an active ConnectorCare plan are required to submit a MassHealth determination annually (NOTE:  HDAP clients who are age 65 and older and have already received a denial from MassHealth for “income and assets” do not need to reapply annually). HDAP’s recertification reminder letter should indicate if a client is due to submit a new MassHealth determination. HDAP may be able to accept the first and last page of a recently submitted MassHealth application to grant temporary HDAP approval pending a MassHealth determination. 

Contact HDAP or BRIDGE with any questions

Insurance policies are at risk of cancellation if CHII does not receive a monthly premium statement. 

This process is especially important for CHII clients enrolled in coverage through the MA Health Connector, as these premiums sometimes change as a result of federal and state income verification checks or an expired request for information from the Health Connector. 

When HDAP clients are approved for coverage, a letter is faxed to the client’s pharmacy that identifies the client’s health insurance and the maximum medication co-pay that can be billed to HDAP. 

Failure to update HDAP when an enrolled client’s insurance coverage changes could impact a client’s ability to pick up medications due to a change in co-pay amount. 

For clients who are also enrolled in our Comprehensive Health Insurance Initiative (CHII) program, failure to report a change in insurance could result in termination of coverage if a client’s insurance premium has increased and our CHII program has not been alerted. It could also result in a client owing a refund to our CHII program for money paid on an insurance plan that is no longer active. 

Please fax insurance change information to HDAP as soon as possible via fax number 617.502.1703. 

AccessHealth MA recommends that you submit HDAP standard (long-form) applications and short forms at least two weeks, but no more than six weeks, prior to a client’s termination date. 

Submitting your applications and short forms within this recommended window is ideal for processing by the HDAP team and for clients to be recertified in a timely manner. 

Visit our HDAP Application Page for more information

Comprehensive Health Insurance Initiative (CHII) FAQs

People who are HIV positive and applying to HDAP can request CHII in their HDAP application  (as part of a new application or when recertifying). Clients who are already enrolled in HDAP can request assistance from CHII at any time during their enrollment in HDAP.

  • If you are applying to CHII to cover the cost of your premium, please include a copy of your most recent health insurance premium (bill) with your HDAP/CHII application, or fax it directly to us at 617.502.1703.
  • To send your premium bill via email, please use our secure email system. 
  • If you are applying for assistance for your employee premium deductions (current employer-based insurance), please contact HDAP staff  for guidance.

Find the application and instructions here

Yes, please complete the HDAP section and be sure to fill out the CHII section of the application. Include a copy of your most recent health insurance premium bill. 

Find the application and instructions here 

No, HDAP/CHII is a payer of last resort. If you are eligible for other entitlement programs which pay for medications (such as MassHealth or Medicare Part D), you must apply to and enroll in these programs. 

If you are applying for assistance with your employee premium deductions (current employer-based insurance), please contact HDAP Staff  for guidance. 

Contact AccessHealth MA’s BRIDGE Team (Benefits Resources Infectious Disease Guidance and Engagement) for assistance filling out the application. Send CHII a copy of the most recent health insurance premium bill, Attn: CHII Manager. CHII will then make the payment to the insurance provider on your behalf.

CHII can help pay for the following:
  • Private health insurance premiums 
  • Insurance premiums through the Massachusetts Health Connector
  • MassHealth premiums  
  • Medicare Part B, C, and D premiums 
  • COBRA premiums
  • Employee premium deductions 
  • Self-employed private insurance premiums 

Looking for…?

Navigating Insurance

BRIDGE to care

Our BRIDGE Team helps clients understand the complicated insurance landscape and choose the best option for their unique circumstances. The BRIDGE Team is skilled at addressing barriers to coverage and can help clients access all the services offered by AccessHealth MA.

Learn more about BRIDGE Support

Outreach and Training

View previous trainings or schedule a training with our BRIDGE team

The BRIDGE Team provide training to case managers, healthcare providers, and clients about accessing our drug assistance programs, as well as insurance enrollment.

Learn more

Financial Support

Comprehensive Health Insurance Initiative (CHII)

Our Comprehensive Health Insurance Initiative (CHII) helps people living with HIV enrolled in our HDAP program access the best health insurance available to them by paying their monthly health insurance premiums.

Learn more about CHII

Tax Credits

Need help navigating Premium Tax Credits?

The Affordable Care Act provides tax credits to eligible individuals and families who are enrolled in health insurance through the Massachusetts Health Connector. These Advanced Premium Tax Credits (APTCs) are subsidies that lower the cost of your monthly health insruance premiums, which HDAP/CHII may have paid on your behalf.

Learn more about Premium Tax Credits

Contact us

Reach out to us at anytime

If you have any questions about BRIDGE, their trainings and webinars, health insurance enrollment, or other HIV-related trainings, please contact our BRIDGE team

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