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MassHealth enrollment down by more than 110,000

This chart shows MassHealth enrollment and departures from April to October of 2023.
Chris Lisinksi
This chart shows MassHealth enrollment and departures from April to October of 2023.

About 88,000 more people lost MassHealth coverage in October, the largest monthly decline yet in the year-long effort to reassess eligibility for 2.4 million members, and most of those losing coverage to date have been dumped for procedural reasons.

Through the first seven months of the process in Massachusetts, 46% of people kicked off MassHealth lost their coverage because officials confirmed they no longer qualify. Another 52% lost coverage because state workers did not have enough information to assess eligibility, state officials said.

Data published by state health and human services officials on Tuesday show that the state's combined Medicaid and Children's Health Insurance Program rolls have dropped by a cumulative 112,000, or 4.67%, since April.

Officials said they still believe the number of disenrollments will nearly triple over the five remaining months in the federally required redetermination campaign, forecasting a sizable jump this winter following open enrollment at the Massachusetts Health Connector.

The Connector, a state-run insurance marketplace that also offers some subsidized coverage options, has seen a significant uptick in interest as the redetermination process unfolds. MassHealth officials said Tuesday that enrollment through the Connector has grown by 38,000 since April, suggesting "a large portion of the individuals who have lost MassHealth eligibility are able to obtain affordable coverage" with policies offered through the insurance clearinghouse.

All 50 states are undergoing similar efforts to reassess eligibility for Medicaid plans.

The federal government prohibited removing people from Medicaid during the COVID-19 pandemic in an attempt to keep Americans covered, but that requirement ended this year. States must now figure out who still qualifies for publicly funded health insurance and who needs to be removed from the programs.

About 22,000 people newly enrolled in MassHealth in October, a roughly average amount that partially offset the 88,000 departures, according to the data.

Healey administration officials projected at the start of the campaign that it would lead to a net reduction in MassHealth enrollment of 300,000 to 400,000 members, freeing up $1.9 billion in funds that are being used elsewhere in this year's state budget. Assistant Secretary for MassHealth Mike Levine said Tuesday those annual estimates still hold.

"We do anticipate a significant number of members to lose coverage between now and the end of the year as part of the typical annual trends we see around the open enrollment [period]," added MassHealth Chief Operating Officer Elizabeth LaMontagne.

The share of disenrollment for procedural reasons has been increasing in recent months, and Levine said Tuesday he is grappling with how to interpret the data because it provides a single count for two distinct types of people: those who intentionally ignore contact from MassHealth because they already know they are ineligible, and those who might still qualify but fall through the cracks or cannot be reached.

Some Bay Staters, Levine said, joined MassHealth early in the pandemic, and their life circumstances have changed significantly since then -- for example, they might have gotten a new, well-paying job with employer-sponsored insurance. And because federal requirements prohibited states from disenrolling people before the redetermination campaign kicked off, those people are still on the rolls.

They wouldn't be automatically renewed in MassHealth because the state can see from a tax return or a wage report they earn well above the required income threshold. However, when MassHealth follows up with a "blue envelope" confirming their personal details, such members often do not reply, forcing them to get counted as terminated for procedural reasons.

"It's not in their interest to respond to us, so they don't bother responding, but since we don't get a response from them, we have to put them in the insufficient information bucket," Levine said.

On the flip side are MassHealth members who are likely still eligible, but for whom income information is not available in an existing public database, meaning they can't be automatically renewed. If those people fail to reply to a blue envelope, they, too, get counted as terminated for procedural reasons.

Distinguishing between those two populations in data reports "is not something we've been able to present," Levine said. He added that he has had conversations with Medicaid directors in other states, many of whom are facing a similar dilemma.

Nationally, about 711% of people disenrolled from Medicaid lost coverage for procedural reasons, according to data tracked by health policy nonprofit KFF.

"That includes both categories, and I think that often gets lost -- this includes people who are not responding where there's some indication that they're actually probably over income, as well as people where we don't know either way, but they're not responding," Levine said. "We're in the same kind of reporting boat as everyone else."

One data point Massachusetts officials are watching closely as a way to understand the dynamic is the number of people who rejoin MassHealth after leaving, which totaled about 11,000 in October.

Bay Staters who returned to MassHealth within three months of departing "were probably always eligible, then missed the blue envelope, or something happened that was more procedural," Levine said.

"[That is] exactly the kind of thing that we've organized ourselves around trying to reduce as much as possible," he said.

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