‘Glitch’ deprived some 4,800 Mass. residents of Medicaid coverage

The Centers for Medicare & Medicaid Services announced that 500,000 people in the US mistakenly lost insurance as part of the redetermination process.

A hospital in Mountain Home, Ark.ERIN SCHAFF/NYT

Thirty states, including Massachusetts, are pausing the removal of thousands of people from Medicaid rolls after the federal government identified a “glitch” that had mistakenly deprived half a million eligible people across the country of state-sponsored insurance.

The Centers for Medicare & Medicaid Services said on Thursday that less than 10,000 people in Massachusetts were affected, and state officials later clarified that the number stood at approximately 4,800. Federal officials also initially said the issue likely affected mostly children, but state officials said no children in Massachusetts were affected. All impacted Massachusetts residents will regain coverage, according to the state.

States use an auto-renewal process to determine if people are eligible for Medicaid, using information available through state wage data and other sources. Federal officials say such a process makes it easier for people to renew their Medicaid insurance or remain on its sister program, the Children’s Health Insurance Program.

However, in a media briefing, the federal agency said it had noticed when looking at data and talking to states that the automatic renewal system was assessing eligibility at the family level rather than the individual level, even though individuals in a family might have different eligibility for the program. For example, children are likely to be eligible for Medicaid or CHIP even if their parents no longer qualify.

“The most important piece is every single one of those states is required to pause procedural disenrollments for anyone impacted by this glitch, to reinstate people until they can regain coverage, and continue pausing procedural disenrollments until they have a fix in place to ensure no eligible individuals are losing their Medicaid enrollment because of this issue,” said Dan Tsai, director of the Center for Medicaid & CHIP Services, in the briefing.

“We will help stop more families and children from being disenrolled simply because of red tape,” said CMS administrator Chiquita Brooks-LaSure, who also spoke at the briefing.

An official with MassHealth, the state’s Medicaid plan, said Massachusetts had avoided such problems in most cases, because the core system it uses to reenroll most people under the age of 65 looks at individual, not household, eligibility.

However, MassHealth did identify small populations where the eligibility system for people over the age of 65 and for individuals with disabilities was looking at household, not individual, eligibility.

The state is implementing an enhancement to its autorenewal process, and officials hope to renew insurance for affected populations that way. If they are unable to auto-renew this population, the state said it will defer looking at their MassHealth enrollment for up to 12 months.

Federal officials had initially identified the problem in August, and asked states to audit their systems to make sure they were determining eligibility correctly. Initially, spokespeople from MassHealth said CMS’s main concern was disenrolling children, and that wasn’t a problem in Massachusetts, though the state had acknowledged some smaller groups of members might be impacted.

It was unclear how many of those accidentally disenrolled might ultimately still not qualify for state insurance. Tsai said states were in various stages of fixing the problem, but did not provide a breakdown. He said some state fixes would take “months”

To date, over 207,000 people have been disenrolled from MassHealth since April 1 because they were confirmed ineligible, didn’t respond to mail, or because they could not be reached.

Notably, child enrollment in MassHealth has not dropped, but grown. Through the end of August, in data reported Sept. 21, 819,100 people under the age of 20 were enrolled in Medicaid, up from 806,200 in April, when the state began redetermining people’s eligibility.

Massachusetts began looking at people’s eligibility to be on MassHealth in April, as part of a nationwide restart of what had been an annual eligibility assessment. During the pandemic, federal rules prevented states from removing people from the program, and MassHealth enrollment swelled to 2.4 million.

While thousands left the program in the months since the state restarted its eligibility audit, total MassHealth enrollment still stood at 2.34 million as of the end of August, due to new people becoming eligible and joining the program.

Despite the glitch, advocates involved in the state’s Medicaid redetermination process said Massachusetts was working carefully to make sure that those who were eligible remained insured through the program.

“I genuinely believe MassHealth is doing everything they can to keep people covered,” said Amy Rosenthal, executive director of Health Care For All. “Does it mean the system is totally perfect? No. There are some inherent issues with the way the computer system is designed … that they are trying to figure out workarounds. [Federal data shows] they are holding themselves accountable and being transparent.”

Rosenthal also noted that the number of affected individuals was a fraction of the millions insured by the program.