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"It's Not Just Getting Our Residents Insured, It's Keeping Them Covered" by Christina Severin

Enrolling eligible Commonwealth residents in high-quality, subsidized (Commonwealth Care) insurance plans has been a major thrust of our first-year health reform efforts.
In addition, the push has been to increase MassHealth enrollment based on new “expansion populations” (the largest of these being kids who are now eligible up to 300 percent of the FPL).

Before the launch of health care reform, an estimated 372,000 Massachusetts residents had no health insurance. Today, more than 120,000 residents have insurance as a result of reform. Getting qualified residents coverage is only part of our challenge. We must also ensure they stay covered as long as they remain qualified.

The unfortunate reality is many qualified individuals end up without health insurance coverage for segments of time. This phenomenon – one aspect of “Medicaid churn” – ultimately is not about a recipient’s loss of Medicaid eligibility.

A recent analysis of Network Health’s MassHealth membership shows that 58 percent of people who were involuntarily disenrolled (code for kicked off the Medicaid rolls) were subsequently re-enrolled in MassHealth.

Of those who re-enrolled, 70 percent did so within 90 days. Most were involuntarily disenrolled due to administrative issues such as returned mail (if a MassHealth mailing is returned because a member is no longer at the address on record, that member can be disenrolled. So, if an enrollee moved from an apartment to a shelter, he/she would be dis-enrolled)

Clearly, this data shows that the vast majority of re-enrollments happen within a short time and therefore that we (MassHeatlh really) have an opportunity to avoid thousands upon thousands of gaps in coverage every month. With new rules afoot to give MassHealth members only 45 instead of 60 days’ notice of their renewal dates, disenrollment rates are only likely to increase and with them the volume and length of coverage gaps.

As the new Safety Net Trust Fund (Pool) regulations are issued, which limit eligibility for free care services, the problem becomes one that we can’t ignore. More and more, we will have hospitals, health centers and low-income families left holding the bag during coverage gaps since these members would be deemed ineligible for pool coverage since they were “eligible” but not enrolled for MassHealth. We don’t want to find ourselves making progress at the front door and losing those gains through the back door- which is what we have right now- five steps forward, three steps back.

Presently, the gap represents a lose-lose situation for MassHealth members and providers. Members lose coverage and access to key preventive care; providers must choose between providing truly “uncompensated” care or no care. The gap also generates tremendous costs for the state due to the administrative burden associated with member churn.

The answer to continuity of coverage conundrum, if there is one, might be found in the potential savings that would be realized by reducing the churn. I’m not sure if anyone’s ever study this (eg: Massachusetts Medicaid Policy Institute). This is a very important issue and one that is very contemporaneous given this issuance of the new Safety Net Regulations. It is also an issue that is very germane to the principles goals of Chapter 58- that of getting, and keeping, all Massachusetts residents insured.Christina Severin is executive director of Network Health, a health plan with more than 135,000 low- and moderate-income members with state-subsidize health insurance across Massachusetts.

This program aired on September 25, 2007. The audio for this program is not available.

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