A daunting project to verify whether 1.2 million Medicaid enrollees qualify for the program entered its second phase this month, as tens of thousands of people with disabilities received letters telling them they need to reapply for benefits.
MassHealth, the state’s Medicaid program, needs to reach a diverse group whose limitations can be physical or mental and who will have to fill out lengthy forms to maintain their health coverage.
“There are going to be problems,” said John Winske, executive director of the Disability Policy Consortium, an advocacy and research group in Boston. “Any time you have thousands and thousands of people mailing in an application, there’s just so many chances for things to get fouled up.”
The unprecedented reenrollment effort requires the state to balance two goals: ensuring that citizens have health coverage and controlling costs in the sprawling, $15.6 billion health program for low-income people. Governor Charlie Baker has projected major savings from removing ineligible people from the MassHealth rolls.
In the past, MassHealth reenrollments occurred on a rolling basis. That process came to a halt in October 2013 because of a software failure at the Massachusetts Health Connector , which was supposed to determine whether people qualified for MassHealth or another type of coverage.
For 15 months, everyone on MassHealth stayed in the program without having to file papers showing they remained eligible. Then the federal government, which pays for half or more of MassHealth costs, required the state to verify those people’s eligibility by the end of 2015.
Dennis Heaphy, cochairman of Disability Advocates Advancing Our Healthcare Rights, raised concerns about performance of the MassHealth helpline, which he described as “notoriously inefficient” and prone to giving out misinformation. He added that the state has been “working diligently” to improve the call-in service, which can expect heavy demand during this time.
Heaphy also worries about reaching people who have intellectual disabilities or who are homeless.
Both Winske and Heaphy emphasized, however, that they welcomed the state’s efforts to reach out to advocates, and they praised the work to spare many people from even having to go through the reenrollment process.
MassHealth automatically reenrolled 266,000 people, including 66,386 people with disabilities, after confirming that they were eligible because they qualified for such programs as Social Security Disability Insurance or the Supplemental Nutrition Assistance Program, commonly known as food stamps.
“I’m glad that they’re being smart about it and trying to lessen the number of people who have to go through the headache of filling out forms,” Winske said.
Daniel Tsai, assistant secretary for MassHealth, said a key lesson gleaned from the effort to reenroll Medicaid recipients is the importance of partnering with people in the community who know MassHealth members best, including advocates and medical professionals.
The project got off to a rocky start in January, as the state tried to enroll 500,000 people in three months. After phone lines and health centers were overwhelmed by confused and panic-stricken enrollees, the deadline was extended to June 30.
Of the 500,000 people whom the state tried to reach in the first half of the year, 387,000 — 78 percent — completed the 26-page form to determine whether they still qualified for MassHealth.
“We learned a lot,” said Marylou Sudders, secretary of health and human services, noting that in previous reenrollment efforts, an average of 70 percent of recipients were reached. “We added things as we went along. We were nimble and really listened for feedback.”
Amy Whitcomb Slemmer, executive director of Health Care for All, an advocacy group that helped with outreach, said no one knows why 113,000 did not reply by June 30.
“I would love to think they didn’t respond because they have coverage some other way,” she said.
Worried that many of the people were not responding because they did not speak English, Health Care for All held a statewide advertising campaign in ethnic media. Ads in nine languages ran in 91 outlets during the last two weeks of June, resulting in 600 additional calls to the agency’s help line.
People who qualified for MassHealth because of low incomes are most likely to have changing circumstances that would affect eligibility.
The state worked with community health centers to reenroll people when they came for care or called with questions, a practice MassHealth executives said they intend to continue.
“We want to be able to meet our members in that way — where they get care,” Tsai said.
The agency also supplied health insurers with the names of their members who hadn’t replied, so that the insurers could do their own outreach. About two-thirds of MassHealth members are enrolled in health plans that have contracts with the state.
“We’re not hearing a lot of complaints,” said Lora Pellegrini, president of the Massachusetts Association of Health Plans. She said the first phase had ended well.
In the first week of August, letters went out to 62,255 MassHealth members with disabilities who need to confirm their eligibility. That will be followed by Sept. 1 letters to 129,000 people who qualified for MassHealth because of low incomes, and Oct. 1 letters to 27,000 whose premiums for employer-sponsored health insurance are paid by MassHealth.
MassHealth started the year with about 1.9 million enrollees. Of these, 700,000 had signed up recently and didn’t need to reapply. An additional 200,000 either left the program by normal attrition — such as death or moving out of state — or had applied on their own.
Felice J. Freyer can be reached at firstname.lastname@example.org.