Thousands Ruled Ineligible For Mass. Medicaid

Tens of thousands of people have been removed from the state's Medicaid program during the first phase of an eligibility review, according to figures from Gov. Charlie Baker's administration obtained by The Associated Press.

The eligibility checks, required annually under federal law but not performed in Massachusetts since 2013, began earlier this year as part of Baker's plan to squeeze $761 million in savings from MassHealth, the government-run health insurance program for about 1.7 million poor and disabled residents.

At $15.3 billion, MassHealth is the state's single largest budget expense.

Based on the results of the redetermination process so far, the state was on track to achieve the savings it had hoped for in the current fiscal year without cutting benefits for eligible recipients, said Secretary of Health and Human Services Marylou Sudders.

The first phase of the process involved letters sent to 503,286 Medicaid recipients over the first six months of the calendar year notifying them of the need to reapply for benefits, according to numbers provided to the AP by the Executive Office of Health and Human Services.

Final figures were not expected until Aug. 1, but of the nearly 293,000 applications processed through late June, 78 percent remained eligible for Medicaid based on income. Of those deemed ineligible, the majority will have access to subsidized private insurance through the state's health connector, though about 5 percent, according to Sudders, would not qualify for subsidized coverage.

The results of the eligibility redeterminations to date, Sudders said, were in line with the typical rate of change in the Medicaid population and she did not believe it had deprived deserving residents of coverage.

"Given the fact that the history is that 30 percent of MassHealth population turns over every year, and (nearly) 80 percent of the individuals who contacted were re-enrolled, I feel OK about that number," she said. "If that number had been 50 percent, I would say there has to be people out there eligible for MassHealth we are not finding."

Yet the figures also show about 116,000 people, or 23 percent of the total number in the first redetermination phase, have yet to respond to multiple requests from the state and will be dropped from MassHealth, said Sudders. Any who subsequently resurface would be offered care on a fee-for-service basis until their eligibility is determined, she added.

The state enlisted the independent advocacy group Health Care For All to help get the word to Medicaid recipients statewide that they needed to reapply to maintain their benefits.

The organization's campaign includes media ads in nine languages.

"We want to make sure that anyone in Massachusetts who qualifies for MassHealth has access to MassHealth," said Amy Whitcomb Slemmer, executive director of Health Care For All. "It's a life-saving insurance program."

Officials say they suspect that most people who did not reapply had left the state or no longer needed the benefits due to other life changes. Slemmer said she hoped many had moved into private health coverage.

In what Sudders called a first-of-its-kind move, the state extended Medicaid eligibility for more than 48,000 recipients who did not respond to the state inquiries, but made some sort of recent contact with the system - a visit to a community health center, for example, or even a phone call to MassHealth.

State budget writers had expected the redeterminations to save about $200 million in the fiscal year that started July 1.


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