More than 60,000 members lost MassHealth coverage in July

A third of a way into a sweeping effort to reassess MassHealth eligibility for roughly 2.4 million Bay Staters, the anticipated wave of disenrollment is beginning to appear.

Nearly 61,000 members lost MassHealth coverage in July, significantly more than in any of the three previous months of the year-long redetermination campaign, according to state data published Thursday.

In recent months, the losses were offset by roughly average new enrollment. But July's changes newly pushed total enrollment in the state's combined Medicaid and Children's Health Insurance Program rolls to a bit less than 2.39 million, or 0.6% below the 2.4 million caseload on April 1 when the redetermination in Massachusetts began.

"This is exactly what we expected, and is the beginning of several months of caseload declines that we expect to see in the months ahead," said Mike Levine, the state's assistant secretary for MassHealth.

About 127,000 Bay Staters have cumulatively lost coverage since Massachusetts officials kicked off the first post-pandemic review of every member's eligibility. Federal policy blocked disenrollment of Medicaid recipients during the pandemic, and that measure has since lapsed, requiring all 50 states to embark on a similar redetermination endeavor.

Levine said based on the trend so far, there's "no change" to the Healey administration's forecast that 300,000 to 400,000 people would depart MassHealth over the course of the process. Budget-writers expect that shift will free up $1.9 billion in state funds this fiscal year that can be redirected.

A bit more than 77,000 people have lost MassHealth coverage so far because they were confirmed no longer eligible. Close to 45,000 others were disenrolled because they failed to provide the state with enough information to reach a conclusion, and 4,500 more could not be contacted by officials.

That means roughly 40% of Massachusetts residents kicked from Medicaid so far lost the publicly-funded insurance due to procedural reasons.

An unknown number of people who lose MassHealth likely know they are no longer eligible and ignore state outreach, Levine said. They might have shifted to a private plan through an employer earlier in the pandemic but never left the rolls.

"We don't distinguish between the people who know they are not eligible and are not going to bother to fill out a form to tell us that they're not eligible, and those who may, in fact, be eligible, but life gets in the way and they don't see [the form], they don't get it," he said.

Levine added that he's "not sure" the ideal rate of procedural disenrollment.

"It's not zero, because again, who's going to take the time to fill out something if they've been on private insurance for the last two years and don't want or need Medicaid?" he said.

Close to 75% of disenrollments across the country stem from procedural reasons rather than ineligibility, according to data tracked by the Kaiser Family Foundation.

But Levine said it's "too early" to tell if Massachusetts is faring better at minimizing those kinds of cuts compared to other states, and he forecast that the share of procedural disenrollments here will climb in the coming months.

"Remember that some states started in February and they had a head start on us. We also really took a measured ramp-up approach so that in April and May, we weren't selecting a full one-twelfth of our membership," Levine said. "I do expect as we try to renew more people, we will get more non-responses, and you will see our percentage tick up."

In 2018 and 2019, before COVID-19 hit, MassHealth typically saw about 52,000 members depart the rolls per month, officials said.

Officials have automatically renewed coverage for members whenever possible if those individuals are still eligible, most of whom were previously renewed or newly applied for coverage in about the past year, according to Levine.

MassHealth members get "a couple bites at the apple" to prove they are still eligible for coverage once they are selected for review, Levine said.

Anyone who receives a now-famous "blue envelope" in the mail has 45 days to provide requested information via phone, mail or web. If they fail to reply in that span, officials make another pass at examining data they already have on hand to figure out if the person is eligible for renewal.

The next step is a termination notice, which alerts a member their coverage will end in 14 days and that they can contact MassHealth if they think the decision is in error. After that, former MassHealth members have 90 days from the time their account is closed to provide the missing information and get their coverage retroactively reinstated if they were in fact eligible.

MassHealth chief operating officer Elizabeth LaMontagne said the state has supplemented blue envelopes with emails, texts and a robocall campaign, plus outreach alongside Health Care For All and health plans to try and reach as many people as possible.

So far, she said, call centers and other member services are handling the increased demand.

"We're still seeing low wait times and we're not seeing high abandonment rates, not seeing issues getting through to staff," LaMontagne said. "Our contact center is performing well and making sure we have that capacity to support our members."

State law requires everyone to have health insurance or face a tax penalty, so people who lose MassHealth eligibility must enroll in an employer-sponsored plan or secure coverage through a plan offered on the Massachusetts Health Connector marketplace.

Although officials track new enrollment in plans on the Health Connector among former MassHealth members, they say they lack a global tool to monitor how every single disenrolled recipient acquires coverage.

"That's a great question, and it's one that keeps us up at night," Levine replied when asked if people who lost MassHealth eligibility for procedural reasons moved to other coverage or now have no health insurance. "I think if they were already enrolled with the Connector, we probably would have had a different outreach strategy with them. There's a lot of work that [the Center for Health Information and Analysis] and others do to track enrollment rates over time, and we suspect that many of them do have coverage."