Approximately a third of the state’s population is about to have to re-enroll in MassHealth, a massive undertaking that state officials project will ultimately remove approximately 300,000 people from state-sponsored health insurance.
As of February, approximately 2.3 million people were enrolled in the state’s Medicaid program, a 25 percent increase from before the pandemic. The increase has come not only as an influx of people lost their jobs and health insurance early in the pandemic but also because under federal rules, the state has not reassessed people’s eligibility to remain on the program for three years.
As the federal government puts COVID in the rear-view mirror, the normal annual eligibility process will resume starting in April, requiring millions of state residents to take action to retain their health insurance over the next 12 months.
Governor Maura Healey unveiled the projections in a fiscal 2024 budget proposal on Wednesday, detailing that, due to the redetermination effort, the state expects to spend $19.8 billion on MassHealth, nearly $2 billion less than this year.
“We know what we’re facing right now this spring with redetermination. We know the work that we need to do, and I know the team is very focused on that . . . so that we have a smooth transition as possible,” Healey said at a press conference announcing the budget proposal. “I think [the 300,000 number] reflects our best-educated estimate of what is necessary and appropriate to meet this moment and the needs of folks who have been accessing MassHealth.”
In some ways, the process of assessing people’s eligibility will mirror what has happened in the past. The program used to review members’ coverage annually and tried to auto-renew people by matching their information to state and federal data sets.
But this year, the state will reassess 25 percent more member applications than usual, a number that might grow over the next month, state officials project.
“We want to make sure people end up in the programs they should be in,” said Hannah Frigand, director of education and enrollment services with Health Care for All, which is leading a public outreach campaign around the signups. “At the end of the day, it’s not about making sure MassHealth has the highest number, but that people are on the coverage they should be on.”
The state has continued to send out renewal forms to members even during the pandemic, as allowed under the federal guidelines, so as not to disrupt people’s renewal schedules and have up-to-date information. But those who haven’t responded have faced no repercussions. Those who responded but were ineligible for MassHealth have not lost coverage over the last three years.
“People are going to need to know they have to take action,” Frigand said. “Any time people get out of the practice of taking action, it’s harder to get people to do something.”
Many say the state has worked hard to prepare, given the scope of the undertaking.
In the past, the renewal application would automatically renew as long as the reported income fell within 10 percent of what was reported on state and federal databases, if they were able to be matched. That has been increased to 20 percent.
Members over the age of 65 will still have to fill out a paper application, a legacy of the state’s older system. However most members will now be able to fill out a shortened 10-page application, down from 38 pages. The state has also moved part of the process online.
To handle an increase in applications, the state has hired more than 150 additional people at MassHealth Enrollment Centers and increased frontline customer service agents from 300 to almost 500.
The state has also partnered with Health Care For All on a large-scale outreach campaign, providing $5 million to undertake door-knocking, conduct outreach with community-based organizations in 15 communities where the majority of MassHealth members live; and do a public education multimedia campaign in nine different languages. Insurers, primary care providers, and more are also being included in the campaign, to help raise awareness of the importance of responding to MassHealth requests.
Yet there will likely be challenges. Before the pandemic, one in 10 people on Medicaid or the state’s Children’s Health Insurance Program lost coverage not because they weren’t eligible, but because they failed to turn in the required paperwork, according to a report from the Blue Cross Blue Shield of Massachusetts Foundation.
“MassHealth’s significant enrollment growth over the past two years, together with operational challenges that include a strained enrollment workforce and a high volume of returned mail as a result of individuals who have changed addresses during the pandemic, creates a ‘perfect storm’ that puts eligible individuals at risk of losing coverage,” the foundation wrote in an April 2022 report.
Audrey Shelto, president and chief executive of the Blue Cross Blue Shield of Massachusetts Foundation, said while there will be a risk of people losing coverage across the country during the redetermination process, Massachusetts has taken a leadership position to be ready, not only developing a plan but also incorporating suggestions such as including text messaging and using colored envelopes for mailings.
“It is going to be disruptive, as it is throughout the country, but Massachusetts has been working hard and preparing for this,” Shelto said. “It doesn’t mean those challenges aren’t there, but the state has done a good job getting ready for them.”
State officials have had practice with a redetermination effort of this size. In 2014, the state’s health insurance marketplace broke as the state tried to redesign it to comply with new federal rules, leaving officials unable to determine if people were eligible for MassHealth.
However, unlike 2014 and 2015, the state’s website is working. People will be able to enroll in a plan on the state’s Health Connector or through their employer should they lose MassHealth coverage.
“Hopefully people are cleanly going back to where they should be going,” Frigand said. “But it will take time and we will have to evaluate how the market sorts itself out.”
Samantha Gross and Matt Stout of the Globe Staff contributed to this report