Massachusetts Insurance Connection for Individuals with AIDS or HIV (Closed to New

Applicants) (A) Introduction. The Massachusetts Insurance Connection for Individuals with AIDS or HIV Program (MIC) is a health insurance buy-in program administered by the MassHealth agency for individuals with acquired immunodeficiency 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 their 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 MIC (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 has comprehensive coverage, as determined by the MassHealth agency on an individual basis; (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; and (6) in conjunction with their 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. (C) MIC Members Eligible for a MassHealth Coverage Type That Provides or Pays for Comprehensive Coverage (1) Members cannot be simultaneously enrolled in MIC and a MassHealth coverage type that provides or pays for comprehensive coverage. (2) If a MIC member is found eligible for a MassHealth coverage type that provides or pays for comprehensive coverage, the MIC member shall have 30 days to choose either continuing their enrollment in MIC or enrolling in the comprehensive MassHealth coverage. When a member is eligible for both MIC and comprehensive MassHealth coverage and does not choose between the two, the member shall by default keep their current coverage type. (3) The MIC member shall be disenrolled from MIC when they choose to enroll in a comprehensive MassHealth coverage type. (4) A former MIC member will lose the continuous enrollment status described in 130 CMR 522.001(B)(1) if they are enrolled in comprehensive MassHealth coverage for six months or more. (5) During the first six months after disenrolling from MIC and enrolling in comprehensive MassHealth coverage, the member may request to go back to the MIC Program, be disenrolled from their comprehensive MassHealth coverage type, and be considered continuously enrolled in MIC under 130 CMR 522.001(B)(1). Such disenrollment from comprehensive MassHealth coverage shall be treated as a voluntary withdrawal from their MassHealth coverage. (6) An MIC member who disenrolls from MIC to enroll in comprehensive MassHealth coverage shall be given written notice of their rights under 130 CMR 522.001, including how MassHealth enrollment affects their future eligibility for MIC as described in 130 CMR 522.01. (D) 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 Supplemental Security Income; and (3) documentation of gross annual income. (E) Redetermination of Eligibility. The MassHealth agency completes a redetermination of eligibility for each program participant on an annual basis or as needed. (F) 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 their death; and (b) if a qualified individual relocates to another state, they 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.