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About 69,000 residents have lost MassHealth coverage as state continues eligibility review

MassHealth data show nearly 70 percent of Bay Staters who have lost coverage since a year-long redetermination process began were deemed ineligible to remain enrolled.
MassHealth data show nearly 70 percent of Bay Staters who have lost coverage since a year-long redetermination process began were deemed ineligible to remain enrolled.

More than 33,000 Bay Staters lost MassHealth coverage in June after being dubbed no longer eligible or failing to provide enough documentation, officials said Tuesday.

Since the state kicked off a year-long eligibility review of all 2.4 million members in April, just shy of 69,000 people have been stripped from the MassHealth rolls, according to new data published by the Executive Office of Health and Human Services.

Nearly half of that reduction took place in June, the third month of the process. In a summary of the latest data, MassHealth officials called the trend "an expected modest increase" after the first two months did not show sizable changes.

Close to 70% of those who were removed from the state's combined Medicaid and Children's Health Insurance Program rolls were found ineligible for the publicly-funded health insurance coverage following review, the data show.

Around 12,300 people, or a bit less than one in five who have lost coverage so far, were booted because they failed to provide MassHealth with requested information that would show if they are still eligible. Another 3.6% — about 2,500 people — departed the rolls after their mail was returned to MassHealth and they did not respond to other methods of outreach.

Disenrollments stemming from paperwork gaps or a recipient's failure to respond, rather than because of ineligibility, appear to be far more common in other states so far. The Kaiser Family Foundation estimated Monday that three-quarters of people who have lost Medicaid coverage during the nationwide eligibility review, which started earlier in some states, were removed because of procedural reasons.

"High procedural disenrollment rates are concerning because many people who are disenrolled for these paperwork reasons may still be eligible for Medicaid coverage," the group wrote.

For most of the COVID-19 pandemic, Medicaid recipients were able to stay in the program without facing scrutiny of their eligibility, but those protections ended this year and states across the country must now reassess who can remain on the rolls.

Since launching the redetermination project on April 1, MassHealth has opened eligibility reviews for 331,000 members. It's not clear how many of those have already received a decision and how many are still pending.

The Healey administration expects total MassHealth membership to fall by between 300,000 and 400,000 people by the time the year-long effort concludes, freeing up $1.9 billion in state spending in fiscal year 2024 that can be redirected elsewhere.

But those deep cuts have been slow to arrive, partly because officials have been slowly ramping up the number of concurrent reviews and partly because it can take nearly two months for someone to lose coverage. Members get 45 days to reply to the state when asked for more information to determine their eligibility, and even if they fail to respond and get disenrolled, they have another 14 days before coverage ends.

Despite the cumulative loss of nearly 69,000 members, the net change in MassHealth enrollment since the redetermination effort started has in fact been a slight increase, from 2.401 million to 2.406 million, fueled by regular new sign-ups.

Most of the people who left MassHealth last month, about 23,000, were between the ages of 21 and 64. Another 5,857 were younger than 20, while 3,937 were 65 or older.

A bit more than 13,000 people disenrolled in June, or nearly 40 percent, live in one of 15 "priority communities" that MassHealth officials believe have the most residents at risk of losing coverage. Those communities are Boston, Brockton, Chelsea, Everett, Fall River, Framingham, Lawrence, Lowell, Lynn, Malden, New Bedford, Quincy, Revere, Springfield and Worcester.

Health insurance is required in Massachusetts and people losing MassHealth eligibility must obtain private insurance through their employer or spouse's employer, secure a plan offered through the Health Connector, or face tax penalties for not being insured.

Data published by the Health Connector on Tuesday show nearly 17,000 former MassHealth members have enrolled in a plan available through the state-run marketplace since losing coverage.

About 55,000 people are eligible for an offering through the Connector after losing MassHealth coverage, including ConnectorCare, a subsidized plan or an unsubsidized plan, the report said.

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