New Form and Process for EMAC Appeals

Not surprisingly, most organizations appealing their EMAC Supplement assessments for reasons other than having less than 6 employees, an employee(s) is an independent contractor, or the employee(s) had less than 56 days of continuous coverage were immediately denied the appeal. If this describes you, you checked off “other”, then read on…

Many of our clients appealed charges and checked off “other” for one of two reasons: 1) the employee was enrolled in the employer-sponsored health plan, or 2) based on earnings it appeared the employee was not eligible for subsidized public health care coverage. These requests were immediately denied as the DUA’s initial process was narrow in scope and they were inundated with appeals.

Angry? So were a lot of employers! So much so, that the Baker Administration has come up with a new form and process for EMAC Appeals by which employers can request the DUA provide re-determination of eligibility for MassHealth or ConnectorCare coverage. If your appeal was for either of the above reasons and the employee is deemed not to be eligible for these programs, then the EMAC Supplement assessment appeal should be granted.

What Do I Need to Do?

To re-appeal, or appeal for the first time, you’ll need to:

  1. Complete an EMAC Employee Information Form for each individual (one form per appeal request).
  2. Submit the form(s) and any supporting documentation by secure email to EMACemployeedata@State.MA.US (you will need to send one email and one form/supporting documentation per request – do not batch forms into one email!)
  3. All forms are due by June 30, 2018!

What Happens Next?

MassHealth and/or the Connector will review your request and if the information you provided confirms that the employee was not eligible for subsidized benefits, you will be credited by the DUA in the next quarter. Please note, you will not hear back directly from MassHealth or the Connector regarding any specific members due to federal and state privacy laws; this means if you receive credit you will not know who the credit is attributable to or how it was calculated.

As always, contact any member of the Sullivan Benefits Team with any questions, comments or requests for more information. The above information and links to outside resources are for informational purposes only.

(774) 369-0280

Marlborough, Massachusetts