Health Safety Net Regulations

The Health Safety Net (HSN) is a program designed to help people with low incomes pay for some medical services in Massachusetts. This program was known previously as the Free Care Pool or the Uncompensated Care Pool. Massachusetts' Health Care Reform Law has since changed the program, setting rules and regulations for the Health Safety Net.

Qualifications

• The Health Safety Net is available for Massachusetts state residents only. The household income must be no higher than 400% of the federal poverty level; lower than 400% will qualify. The individual must be ineligible for MassHealth or Commonwealth Care and must be unable to afford insurance from the place of employment. MassHealth and Commonwealth Care are available to Massachusetts residents aged 19 years old or older. MassHealth or Commonwealth Care may decide the recipient is eligible for Health Safety Net and will inform the individual. The person's or family's income and age or the age of children living at home are factors in MassHealth eligibility. Some other possible factors include pregnancy, employment status, disability, HIV status, or breast or cervical cancer in a woman under age 65. Commonwealth Care is for adults aged 19 and older whose income matches or is below set limits based on family size. Additional eligibility requirements include being uninsured and a U.S. citizen or alien with special status for the past five years.

Health Safety Net Coverage

• Coverage varies from one health care center or hospital to the next, but in general the Health Safety Net covers doctor visits, emergency room visits, hospital stays and prescription medication costs. The Health Safety Net program suggests that recipients visit a health care center when they are healthy to inquire about the coverage at that facility. An individual who receives treatment must pay for any service not covered by the Health Safety Net program.

Services Already Provided

• Certain MassHealth and Commonwealth Care recipients may be selected to switch to Health Safety Net coverage depending on income or circumstances. Health Safety Net eligibility is then decided by MassHealth or Commonwealth Care, and the decision and information are sent to the individual or family. The Health Safety Net may be used to pay for services provided up to six months before the person received Health Safety Net benefits. If MassHealth determines a person is eligible for MassHealth Essential, MassHealth Basic or Commonwealth Care instead, the Health Safety Net benefits can be used to pay for medical services received up to 10 days before the application for MassHealth Essential, MassHealth Basic or Commonwealth Care was submitted.

Costs of Health Safety Net

• The costs of receiving Health Safety Net benefits change depending on the individual's income level. For example, someone whose income is below 100% of the federal poverty level will only pay $1 to $3 for prescription medications, and there are no other costs. For someone earning 100% to 200% of the federal poverty level, prescription medication costs are also $1 to $3, and some hospital services require payments from the individual such as $5 for a doctor visit, $50 for an emergency room visit and $50 for a hospital admission.