AS THE STATE prepares to drop hundreds of thousands of people from the MassHealth insurance program, government and community leaders are hoping for a smooth year-long process – but bracing for possible chaos.
When the COVID-19 pandemic emergency hit, Massachusetts hit pause on the annual process of figuring out who continues to qualify for the state’s Medicaid program for low-income and disabled residents and the Children’s Health Insurance Program (CHIP). Using federal pandemic funding, coverage for MassHealth recipients was automatically extended during the global health crisis.
That’s set to change in just a few days. April 1 marks the first time in three years that the state will begin combing through the insurance rolls to make sure that the only people receiving the coverage are those who are still eligible.
That redetermination process needs to happen for some 2.3 million MassHealth recipients. Mike Levine, the assistant secretary for MassHealth, said in early March that about 300,000 people will likely lose their coverage and be redirected to other health care.
MassHealth officials will have 12 months to work through every member.
“It’s a marathon, not a sprint,” Levine told legislators at a Joint Ways and Means Committee hearing in Arlington on Tuesday. “We’re not redetermining 2.3 million people on April 1.”
For those on MassHealth who still qualify and can be automatically renewed – about half of all recipients, officials estimate – they will get a letter in the mail letting them know that no action is needed. If MassHealth needs updated information, the member will receive a blue envelope in the mail. The member then has 45 days to respond by mail, email, or phone call, which could kick off another three month window to send more information if needed.
These first few months are critical to get a sense of who will no longer qualify, Levine said.
A public dashboard will let residents, community groups, health organizations, and lawmakers track the agency’s progress. MassHealth will launch the dashboard in May, Levine said. It will show anonymized data on where impacted MassHealth members live, their demographics, and why they are losing coverage.
Officials say the 300,000 drop-off is just an estimate, based on coverage rates on the federal level and in states who have updated their rolls more recently. Plus, most of the enrollment growth during the pandemic came from groups of non-disabled adults and children who qualified purely for income reasons, Levine said, so the majority of people who will lose MassHealth will likely be earning slightly too much for the coverage now. Those members will probably still be eligible for subsidized insurance through the Health Connector, he said.
Audrey Morse Gasteier, executive director of the Health Connector, told the board of the state insurance exchange earlier this month that the Connector’s “utmost priority continues to be our careful preparation for the MassHealth redetermination process that will first start in April. We are squarely focused on ensuring that we successfully and smoothly enroll as many as possible of the hundreds of thousands of residents who will newly need health coverage over the course of the next year.”
Who is impacted by the impending eligibility review is of particular interest to equity-focused organizations.
In partnership with MassHealth and the Health Connector, the nonprofit consumer advocacy organization Health Care For All is engaged in a statewide effort to publicize the redetermination. Regional health groups are also working to eliminate coverage gaps.
“With such a massive undertaking, some will unfortunately fall through the cracks,” Amie Shei, president and CEO of the Health Foundation of Central Massachusetts, said at a breakfast event last week. “Those most at risk of losing coverage even though they remain eligible include people of color, those with limited English proficiency, and individuals who are homeless or who experience unstable housing, as they may not receive redetermination notices in the mail or be able to respond promptly. This would undermine our efforts to improve health equity.”
Boston-based Health Law Advocates will be offering free legal assistance to people who may still qualify but incorrectly lose health coverage, Shei said.
The state is also “laser-focused” on outreach, especially to populations that might have a harder time with the process, like older residents, Levine said. Some adjustments have been made to the unwieldy application form, as well, he said, shortening it by 75 percent for those already in the MassHealth program.
Starting in the next few months, MassHealth can also take applications over the phone for residents over 65 years old. The call will probably take 90 to 120 minutes to get through a new application, Levine said, so it may not be the most convenient way to fill out a form, “but it’s a start” to make the process more accessible.
MassHealth is also staffing up in a big way to meet demand, planning to double customer service representatives in their call centers and scaling up their application counselor workforce, he said.
Sen. Cindy Friedman, of Arlington, said that it would probably be a challenge to staff the centers, which Levine acknowledged.
“No one who runs a call center is having an easy time staffing that call center right now,” he said. MassHealth has contracted with two companies to provide additional capacity, he said, and they expect to reach their goal of doubling staffing levels “inside the next six to eight weeks.”
For residents who suddenly find out they might lose health coverage, health officials expect lawmakers will be some of the first to hear from them.
Legislators are bracing for a deluge.
“It seems like we’re going to be the new assistants for all these folks,” state Rep. Russell Holmes said at the hearing. “They’re going to call us frantic.”
The Boston lawmaker said he expects that it will feel similar to the dysfunctional mid-pandemic unemployment system.
Kate Walsh, new health and human services secretary and the former CEO of Boston Medical Center, told legislators on Tuesday that MassHealth has been “practicing” redetermination each month throughout the pandemic to test the system without removing anyone’s coverage. She is hopeful that the IT systems will hold up under strain, she said.
Legislative staffers have already gone through some training, but lawmakers and their offices are in line for more preparation, health officials said. A staff briefing on Thursday will focus on constituent services.
“It’s a difficult process, but we’ve built in belts, suspenders, those little swimmy things,” Walsh said, referring to inflatable arm floaties, “to get us down this river.”