MassHealth, Medicaid redetermination leaves some uninsured

In May, the state completed a massive 14-month effort to verify the eligibility of millions of residents for MassHealth, the state’s Medicaid program, for the first time since the start of the pandemic. During the public health emergency, federal law barred annual eligibility reviews for Medicaid members in order to maximize coverage during the crisis. But starting in April 2023, each state was required to ask members to reapply for the program.

Bạn đang xem: MassHealth, Medicaid redetermination leaves some uninsured

As a result of so-called redetermination, about 363,000 people were cut from MassHealth. At the time, state officials said about a third of those were no longer eligible for the service, and most of the rest lost coverage because they didn’t respond to outreach and appeared to be earning incomes that would have made them ineligible for MassHealth.

State officials say they won’t have an accurate count of Massachusetts’ real number of uninsured people, and who they are, until fall 2025, when US census data are expected to be released.

But recent data from the state’s Center for Health Information and Analysis suggest redetermination may have triggered the largest surge of uninsured residents the state has seen in the past decade: More than 130,000 fewer people were enrolled with major health insurance providers, including most private insurance, Medicaid, and Medicare, than at the same time in 2023.

The CHIA count is not a full tally of Massachusetts’ insured residents because it did not count people with several other forms of insurance, including coverage through Veterans Affairs and federal employee benefit programs. Health officials also noted some of the people counted as uninsured in the report, which was released in September and was based on data from March, have likely gotten coverage since then.

Often, paperwork is the biggest obstacle to obtaining coverage. Missing immigration papers, pay stubs, or Social Security cards can hinder coverage for people who lost MassHealth but are eligible to receive it or participate in the Massachusetts Health Connector marketplace, which offers health insurance for people not covered through their employers.

Xem thêm : Fire home insurance: California insurance commissioner breaks down what not to do if your home is damaged or destroy by wildfire

“It’s sort of a complicated labyrinth for everyone,” said Evonne Yang, assistant vice president of integration, clinical and operational excellence at East Boston Neighborhood Health Center, which serves patients from the city and adjacent communities, including Chelsea, Revere, and Winthrop. “At the height of this [in the spring], we were seeing about four times as many patients as we would typically see coming to us with insurance questions.”

Community health centers, which provide free primary care for people without insurance, often have staff on hand to help people eligible for MassHealth enroll in the program. Yang noted demand for help with insurance has declined significantly in recent months.

MassHealth membership had swelled to nearly 2.4 million as of April 2023.

“It was great for a lot of our patients,” Jones said. “The fact they were able to kind of stay on was great.”

Reviewing membership in 2023 and this year allowed MassHealth to shed recipients no longer eligible for the program. As of November, membership stood at around 2 million.

“A lot of [the decrease] is probably due to people not successfully navigating the renewal process or not finding ability to navigate new insurance coverage,” said Adrianna McIntyre, assistant professor of health policy and politics at Harvard T.H. Chan School of Public Health. “It’s both a lack of information and the hassle costs.”

Experts and state officials anticipated a drop in insurance coverage following the redetermination process, and officials with MassHealth, the state’s Medicaid administrator, applauded a robust outreach initiative that included a focus on the 15 Massachusetts communities where half of all MassHealth members lived.

“It looks like it worked,” said Mike Levine, assistant secretary for MassHealth. “If you look at those communities, MassHealth saw a smaller drop in enrollment.”

Xem thêm : LA Fires, Climate Risks Push California Insurance Market to Limit

Health Care for All led the effort with knocks on 400,000 doors statewide, thousands of events, and community partnerships. MassHealth still has about 260,000 more members now than before the pandemic, Levine said.

“There’s still a pretty massive shift onto Medicaid when you compare today to 2019,” he said.

CHIA reported a significant increase in people covered by private insurance in March compared with June 2023, due in large part to former MassHealth members shifting to the Connector. More than 192,000 people who lost MassHealth coverage joined the Connector between May 2023 and this December, according to communications director Jason Lefferts. The insurance marketplace now has about 344,000 members, its largest enrollment to date.

MassHealth will continue working with community partners to reach people eligible for Medicaid who are not covered, Levine said, and is anticipating federal census data in September that will provide more clarity on the state’s uninsured.

“I think we need a better understanding of who those individuals are and where they are on their way to health insurance,” Levine said.

Ultimately, McIntyre said, America’s fragmented health insurance infrastructure, which forces people to shift the type of coverage they use depending on their employment, virtually guarantees a few will end up without coverage for at least a period of time.

“The uninsured rate is stubborn,” she said. “It’s about the cracks that we create when we ask people to transition across coverage.”

---

Jason Laughlin can be reached at [email protected]. Follow him @jasmlaughlin.