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MassHealth on massive hunt to verify eligibility

State has to check up on 1.2 million people

Simao Mendes, who works in the intake department at the Brockton Neighborhood Health Center, helped Maria Ribeiro of Brockton get her family reenrolled in the MassHealth insurance plan earlier this month. The process took two hours. Felice J. Freyer/Globe Staff/Globe Staff

Locate 1.2 million people. Find even the thousands of them who don’t speak English or don’t have a place to live. Get them to fill out a 26-page application. Process those forms. And get it done by the end of the year.

That is the unprecedented mandate facing state officials this year: to scour the rolls of MassHealth, the state’s Medicaid program for low-income people, and make sure that all the enrollees are still eligible.

Officials stumbled at first with an attempt to reenroll 500,000 people in just three months. There were long waits at the MassHealth call center and long lines at the community health centers. Thousands of other recipients simply failed to do anything. In the end, officials extended deadlines, added staff, and changed policies.


“This was new for us,” said Marylou Sudders, the state’s secretary of health and human services. “We didn’t know what to expect of 1.2 million people.”

The daunting project is a consequence of the 2013 software failure of the Massachusetts Health Connector. The Connector website was supposed to calculate whether people qualified for MassHealth or for another type of coverage, but it was unable to determine anyone’s eligibility. That forced MassHealth to halt its usual process of confirming eligibility, which involves reenrolling recipients monthly on a rolling basis.

As a result, everyone who was on MassHealth stayed on MassHealth, regardless of income increases.

Now the federal government, which pays for half or more of MassHealth costs, is requiring the state to get its house in order. And Governor Charlie Baker is counting on the “redetermination” process to reap big savings — at least $250 million to $300 million in the calendar year — by culling those who no longer qualify.

“I don’t believe any other jurisdiction in the country has had to redetermine so many people in the same period of time,” said Amy Whitcomb Slemmer, executive director of the advocacy group Health Care for All.


“I think the idea that patients can do this on their own is just not realistic,” said Sue Joss, executive director of the Brockton Neighborhood Health Center. “They have to go somewhere for help, and we’re happy to do that. But it’s just overwhelming.” At one point, as many as 70 to 80 walk-ins were streaming into the Brockton health center each day, on top of the 45 with appointments, Joss said.

To help, MassHealth trained 1,300 “certified application counselors” who work in health centers, hospitals, and community groups. The state budget allocated $14 million for all aspects of the redetermination process, with three-quarters of the money coming from the federal government.

The challenges cast into relief the immensity and importance of the state program that provides health coverage for low-income and disabled people.

Forty cents of every state taxpayer dollar goes to MassHealth. The program covers a quarter of Massachusetts residents (including 40 percent of children, half the disabled people, and two-thirds of nursing home residents). MassHealth fuels the economy with payments to hospitals, health centers, physicians, laboratories, health insurers, and more.

The challenge extends from the 11th-floor office of MassHealth director Daniel Tsai to a basement classroom in Brockton, where earlier this month Maria Ribeiro was doggedly scrolling, clicking, and typing her way through a MassHealth application.

The 47-year-old frequently asked for help from Simao Mendes, a worker with the Brockton Neighborhood Health Center, who runs this weekly enrollment class.


Speaking in Cape Verdean Creole, Mendes helped Ribeiro estimate her annual income even though her wages as a cake decorator vary from week to week. He showed her where to click when a red-lettered alert declared a discrepancy in her husband’s income (the box saying he had lost his job). He coached her in identifying her relationship to her husband when the pull-down menu did not include the word “husband” (she located the word “spouse”).

In the end, Ribeiro’s husband and two young sons qualified for MassHealth and were reenrolled, but she was deemed ineligible. Instead, she found a separate plan through the Connector that cost $1 a month after subsidies were applied. Then, she packed away her pay stubs and ID cards, and left — two hours after she arrived.

MassHealth enrolls 1.9 million people. Of them, 700,000 signed up too recently to require reenrollment. The rest need to verify their eligibility, although 200,000 are easily deemed eligible because they qualify for another income-based government program.

Officials decided to first reenroll those who qualified mainly because their income was low. Because income levels can shift, these people were most likely to have changed circumstances that might affect eligibility. The effort started with letters mailed Jan. 15.

But when the April 17 deadline arrived, barely half had taken any action, and many of those who tried to act found they could not get help before their deadline.


Antonia McGuire, president of the Edward M. Kennedy Community Health Center in central Massachusetts, said her centers saw a steady stream of people unable to complete applications on their own.

“The original time frame was ambitious, to put it in a word,” McGuire said.

Several insurers were also raising concerns about possibly losing members and income. About two-thirds of MassHealth members enroll in health insurance plans that receive payments from the state to manage enrollees’ care.

In response, Sudders and Tsai allowed people to file for extensions to June 30. They doubled staff at the MassHealth call center to shorten wait times. And they gave the health insurers lists of members who had not responded, allowing the insurers to contact them and file extensions for them.

“It was a little bumpy in the beginning, but I think it has gotten better,” said Michael Nickey, executive director of MassHealth programs for Fallon Health, a Worcester insurer with about 32,000 MassHealth members statewide.

By early May, the crunch had eased, as thousands filed for extensions.

The number of people responding to the state’s letters steadily increased, reaching 69 percent by Tuesday. The 158,000 who did not respond were disenrolled. But they can get back on the program, with retroactive coverage, if they make contact with MassHealth before June 30.

In July, MassHealth will start reaching out to the next 500,000 enrollees. These include disabled and elderly people and those with complicated family situations. Lessons from the first half-million will shape the approach to the next group. Tsai said he will contact organizations that work with such patients even before the letters go out.


Felice J. Freyer can be reached at felice.freyer@globe.com.