In April, Massachusetts will begin the process of redetermining the eligibility for hundreds of thousands of MassHealth recipients who received coverage protections during the COVID-19 pandemic. As this process unfolds over the next 14 months, it will be critical for state agencies to partner with providers, health plans, community organizations, and others so that people reenroll and Massachusetts maintains its nation-leading status for health insurance coverage.
The federal government provided states with enhanced funding during the pandemic to ensure that people did not lose their coverage through the Medicaid program. In the three years since, the number of MassHealth enrollees has increased by approximately 500,000 people . With federal funding and federal coverage protections set to end, more than half of those people are expected to lose their MassHealth eligibility and will need to find coverage elsewhere, according to numbers released by the Healey administration as part of its budget.
I’ve had the opportunity to speak with my peers at other insurers across the country who are grappling with the same issue. Fortunately, Massachusetts has advantages that will help preserve coverage, including a single eligibility system for MassHealth and Massachusetts Health Connector Exchange coverage, a trusted marketplace for consumers to compare and select plans, and an individual mandate that encourages people to stay insured.
Efforts to prevent the loss of coverage, especially for the most vulnerable populations, are already well underway. MassHealth and the Health Connector have partnered with Health Care for All and other community organizations to knock on doors and talk to members in communities across the state about the need to update their personal information and complete the redetermination process. Both agencies are also working collaboratively with health plans to ensure people receive multiple notifications and assistance in completing the process. The governor’s budget proposal also includes $5.1 million of additional funding for proactive communication with MassHealth members.
MassHealth will issue weekly reports to insurers covering this underserved population about their members who are starting the renewal process, those who previously received federal coverage protections that are expiring, as well as those who have not responded to state outreach and may be at risk of losing coverage for administrative reasons. This data will be critical in assisting insurers with targeted outreach communications to the people who may be at the highest risk of becoming uninsured. For those who are no longer eligible for MassHealth, the communications will share information on other types of affordable insurance products that are available, such as those on the Connector.
In addition to direct outbound member communications, insurers must work with their provider partners in the MassHealth ACO program to raise member awareness about the importance of responding to the MassHealth communications so that they do not experience a gap in coverage. Enhanced operational capacity will be required to assist Medicaid recipients who call with questions about the process or seek additional support.
Despite everyone’s best intentions and vigilance, there is a real possibility that some Massachusetts residents will lose coverage.
There is a significant amount of work in front of providers, health plans, community organizations, and the state. We all must work together to make this process go as smoothly as possible.
Cain A. Hayes is president and CEO of Point32Health .