On MassHealth shift, substantial waves still in distance
Photo | Courtesy of State House News Service
Massachusetts Secretary of Health and Human Services Secretary Kate Walsh
Three months into a year-long campaign to reassess eligibility for all 2.4 million MassHealth members, officials are still waiting for the ripples of disruption to turn into the waves they expected.
"It's a marathon, not a sprint, and we're only at the beginning," said Mike Levine, the state's assistant secretary for MassHealth, while visiting an enrollment center in Worcester.
Or, as Health and Human Services Secretary Kate Walsh put it during a Massachusetts Health Connector board meeting earlier on Thursday: "We haven't even hit Heartbreak Hill yet."
"This is a marathon, and we're going to be at it for the rest of the year," Walsh said.
The Massachusetts Health Connector has seen an influx of people who formerly received publicly funded insurance from MassHealth enrolling in plans offered through the state-run marketplace, but so far, the volume has been fairly small.
More than 16,000 people who lost MassHealth coverage since April 1 have transitioned onto a plan available from the Massachusetts Health Connector, according to Marissa Woltmann, the Connector's chief of policy.
That reflects about 22 percent of people who were deemed no longer eligible for MassHealth but qualify for a plan through the Connector, which Woltmann said is "higher than some of the preliminary data we've seen coming out of other states as well as an assessment of our own data on pre-COVID transitions."
Still, three-quarters of people who lost MassHealth and are now eligible for the Connector have not yet selected an insurance plan offered through the state-run marketplace, according to Woltmann's presentation at a Connector board meeting.
Four out of 10 people in that subset do not qualify for any subsidies to offset the cost of insurance through the Connector, and many of those people have access to coverage through other avenues like an employer-sponsored health plan, officials said.
"We are still relatively early on in the process and haven't yet seen the real steep increase in newly eligible people who are reaching their termination date with MassHealth, but we anticipate those more substantial waves are coming soon," said Connector Executive Director Audrey Gasteier.
Like many other states, Massachusetts saw enrollment in MassHealth -- which combines Medicaid and the Children's Health Insurance Program under one umbrella -- swell during the COVID-19 emergency.
The federal government suspended the requirement for states to regularly assess which members remain eligible for publicly funded coverage, but that ended this year and a nationwide effort is underway that is expected to significantly shrink Medicaid rolls.
Nearly 2 million Medicaid recipients have been disenrolled so far in 29 states and Washington, D.C., according to data tracked by the Kaiser Family Foundation. Nearly three-quarters of people lost coverage for procedural reasons, the group said.
"When you look nationally, especially at some of the states who got a start on this process before we did, there's a lot to be worried about," Levine said. "We're seeing a lot of people who lost coverage. We're seeing a lot of people outside of Massachusetts not get the form or not respond to the form and, as a result, not have health insurance."
MassHealth chief operating officer Elizabeth LaMontagne said at Thursday's Connector board meeting that she expects the state's system will shrink its rolls, which most recently surpassed 2.4 million, to "around 2 million" by the end of the year-long process.
"We're three months in, but as I mentioned, we haven't really seen that significant change in our caseload yet," LaMontagne said.
She described a few reasons for the lag. Officials ramped up redetermination slowly in April and May, which LaMontagne said gave them time to make sure systems were functioning effectively.
It can also take weeks between the start of a review and the conclusion that someone is no longer eligible for MassHealth. Members get 45 days to reply to state inquiries for more information, and even if they fail to reply and get disenrolled, they have 14 more days before losing coverage.
"One takeaway I have is that it is still early days, and I think the 45-day challenge, if you will, starts pretty soon," Walsh said. "People who were in the first wave are starting to hear now."
Through the end of June, which marked one-quarter of the way through the process, MassHealth initiated eligibility redetermination for about 331,000 of its roughly 2.4 million members, LaMontagne said Thursday.
Many of those people will receive the oft-mentioned "blue envelopes" in the mail, signaling they need to provide the state with more information before they find out if they are still eligible to remain covered by the publicly funded health insurance system.
MassHealth opted to steer about 18,000 households back through the renewal process a second time, which LaMontagne said would give them another chance to be automatically renewed with minimal impact.
"It's best for the members to have the opportunity to renew. They don't have to take action, it reduces member burden, and it's the place that we want to land where members are getting the best benefits they're eligible for," LaMontagne said. "It also, from an operational sense, means there's fewer envelopes going out, fewer papers to process, fewer calls to the call center. It's really across the board what we want to make sure we can do: whenever possible, auto-renew someone."
The state has only published data about enrollment changes -- which indicate how many people have lost MassHealth coverage -- through May, or for the first two months of the year-long project.
In that span, about 35,000 Bay Staters left MassHealth, but the rolls shrunk only slightly because new enrollment continued at a roughly average pace.
LaMontagne said the next monthly data should be published later in July.
Levine said MassHealth is "really pulling out all the stops" to achieve a better outcome here than in other states. He said the agency has streamlined the renewal paperwork, making it 75 percent shorter than it was last year before the redetermination process began, and expanded its footprint with new enrollment centers in Worcester and in Chelsea.
MassHealth previously set its sights on staffing up to have more workers who can determine eligibility, process applications and work in call centers.
The state has also partnered with groups like Health Care For All to launch a communications and outreach blitz. Canvassers have knocked on more than 320,000 doors, and community-based organizations have held more than 500 events in the communities most at risk of residents losing MassHealth coverage, according to LaMontagne.
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