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Commonwealth of Massachusetts Executive Office of Health and Human Services

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Commonwealth of Massachusetts Executive Office of Health and Human Services





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Commonwealth of Massachusetts

Executive Office of Health and Human Services

Office of Medicaid

www.mass.gov/masshealth




Eligibility Operations Memo 15-05

March 15, 2015



TO: MassHealth Eligibility Operations Staff

FROM: Amy Andrade, Director, Member and Provider Services


RE: MassHealth and the Federal and State Health Insurance Requirements

for Tax Year 2014


Introduction


Under the Affordable Care Act (ACA), health insurers (including MassHealth) who provide minimum essential coverage to individuals during the tax year are required to provide proof of coverage to those individuals.


In accordance with the Health Care Reform Individual Mandate Requirement section of the health care reform policy, Massachusetts law requires all adult residents who are 18 years or older to have health insurance if they can afford it. Failure to do so may result in penalties. The Massachusetts Department of Revenue (DOR) is responsible for enforcing this requirement through the personal income tax filing system.


This memo covers the federal and state requirements for tax year 2014 and the responsibilities of the MassHealth Enrollment Centers (MECs) in relation to these requirements.


Federal Requirements for Tax Year 2014


MassHealth Members


MassHealth members are not required to provide proof of insurance when they file federal taxes for 2014.


Connector Members


For inquiries about the federal tax filing requirements for tax year 2014 for members enrolled in Commonwealth Care and Health Connector Plans, refer the member to the Health Connector Customer Service at 1-877-MA-ENROLL (1-877-623-6765) (TTY:
1-877-623-7773 for people who are deaf, hard of hearing, or speech disabled).


For inquiries about the tax penalty and Form 1095-A, refer the member to the Internal Revenue Service (IRS) web site. Information about the tax penalty, instructions, and a sample form are available at www.irs.gov/form1095a.







(continued on next page)


Eligibility Operations Memo 15-05

March 15, 2015

Page 3


State Requirements for Tax Year 2014


As in previous years, taxpayers must demonstrate that they had health insurance each month in 2014 if it is affordable for them. As established in 2009, the taxpayer’s health insurance must meet the required minimum creditable coverage (MCC) as set by the Massachusetts Health Connector (Health Connector). This requirement is not set by DOR.


There is no penalty for taxpayers with income that is at or below 150% of the federal poverty level (FPL).


Taxpayers are required to complete Schedule HC (for health care) when filing their personal Massachusetts income taxes. To assist taxpayers in completing this schedule, MassHealth, as an insurance carrier, has issued Form MA 1099-HC to required members. This form identifies the months that the member had MassHealth coverage.


Minimum Creditable Coverage


Minimum creditable coverage (MCC) is the minimum level of benefits needed for taxpayers to be considered insured and avoid tax penalties in Massachusetts.


On the Form MA 1099-HC, MassHealth states that MassHealth coverage meets the MCC requirements.


MassHealth Form MA 1099-HC Recipients


MassHealth issued Form MA-1099-HC to members who

  • had income greater than 150% FPL at any point during the calendar year 2014 or had a category of assistance identifier of AA without regard for income amounts (includes income less than or equal to 150% FPL);

  • had MassHealth eligibility during the calendar year 2014; and

  • are at least 18 years old as of December 31, 2014.


MassHealth did not issue Form MA 1099-HC to individuals

  • with income at or below 150% FPL (except for category of assistance AA) for the time the member had MassHealth coverage (there is no penalty for those with income at or below 150% FPL). This time can be either

  • the entire 2014 calendar year; or

  • only the months the member was covered by MassHealth (partial year); or

  • in one of the following excluded categories of assistance (they are not considered to be insured by MassHealth for the purposes of the Individual Mandate):

  • Family Assistance Premium Assistance (categories V1, 72, 73, 74, and 77);

  • Small Business Employee Premium Assistance (category K1);

  • Health Safety Net (primary, secondary, and partial) (categories AP and AQ) (HSN is not MCC compliant);

  • mental-health benefit only (category 35);







(continued on next page)


Eligibility Operations Memo 15-05

March 15, 2015

Page 3


MassHealth Form MA 1099-HC Recipients (cont.)


  • Qualifying Individuals (QIs) (categories TC, TD, UH, UR, VF, VG, VH, VJ, 88,
    and 89)

  • Qualified Medicare Beneficiaries (QMBs) or Specified Low Income Medicare Beneficiaries (SLMBs) (categories UQ, UV, VC, VD, VE, VK, VL, 22, 23, 24, and 25); or

  • eligible for Commonwealth Care and Health Connector Plans (the Health Connector issues the Form MA 1099-HC for these individuals).



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