MassHealth membership declined 363,000 following massive post-pandemic review - The Boston Globe (2024)

The drop in membership was about what the state had predicted in its latest budget proposal, which allocated $20.3 billion in spending on MassHealth, said Mike Levine, assistant secretary for MassHealth.

“We’re landing about where we thought we’d be,” he said.

The reenrollment, called redetermination, affected about a third of the state’s population and involved an outreach effort to hundreds of thousands considered at high risk of losing health insurance. MassHealth was able to automatically reenroll people whose incomes could be confirmed, but there remained many whose eligibility status was unclear. Those who fell into that grey area had to fill out reenrollment forms and, in some cases, provide additional data to confirm they qualified for Medicaid.

Others no longer qualified and needed help finding alternatives. At the beginning of the process, state officials expressed concern that everyone who might be affected had sufficient notice about the reenrollment process.

“Things could have gone very, very wrong,” said Amy Rosenthal, executive director of Health Care for All, a Boston nonprofit health care advocacy group, which led the outreach effort.

Almost 870,000 people received termination notices from MassHealth over the past year, the state agency reported.

About a third of those who lost MassHealth coverage over the past year were no longer eligible for the service, MassHealth reported. Most of the rest lost coverage because they didn’t respond to outreach and appeared to be making incomes that would have made them ineligible for coverage. Since the worst of the pandemic, many new MassHealth members regained their jobs or found new ones.

It’s unclear how many of the people who no longer qualified for MassHealth found insurance coverage elsewhere, Levine said. Some shifted to Medicare or the state’s health insurance marketplace, but calculating the number who are now enrolled with private insurance will take time, he said.

To help prevent eligible families from losing coverage, MassHealth reached out to the 15 school districts in the state with the most MassHealth members. About 35,300 MassHealth members 20 years old and younger lost coverage from April 2023 to this May, though MassHealth noted the state’s rate of children removed from Medicaid coverage was lower than that of any other state in the country. About 69,000 additional children now use MassHealth than did when the pandemic began, MassHealth reported.

Health Care For All’s $5 million outreach effort included public information campaigns, collaboration with community groups, thousands of events, and canvassers who knocked on doors at more than 400,000 homes. The effort mirrored a similar campaign the organization ran to boost COVID vaccination rates in Massachusetts, and much of it was guided by a grassroots philosophy. Canvassers were typically from the neighborhoods where they knocked on doors, and information was made available in nine languages. Community and faith-based groups became trusted partners in 15 Massachusetts communities where half of all MassHealth members lived.

“When you are genuinely involving members of the community, it works,” Rosenthal said.

The Greater Framingham Community Church was one of the community groups that contributed to outreach at fairs and through one-on-one counseling for people trying to understand their insurance coverage options.

“It makes a difference because the church is centric in the community, and it’s looked upon as being a resource,” said the Rev. J. Anthony Lloyd, the church’s senior pastor.

The church community includes Brazilian and Asian populations, and language difficulties were common. Some sessions with community members lasted for hours, the pastor said, as counselors talked them through the process of reenrolling for MassHealth or finding alternatives.

In the 15 communities targeted in the outreach effort, MassHealth enrollment dropped 14 percent over the past year, the state reported, compared with an 18 percent decline in communities not targeted in the campaign.

For people no longer eligible for MassHealth, support came from the Massachusetts Health Connector marketplace, which offers health insurance for people not covered through their employers. About 133,000 people enrolled in coverage through the marketplace after losing eligibility for MassHealth. About 16,000 accessed the marketplace through a pilot program this year that expanded eligibility to people earning 500 percent of the federal poverty rate.

Massachusetts’ outreach appears to have been one of the most effective in the country, said Katherine Howitt, director of the Massachusetts Medicaid Policy Institute, an independent policy analysis program of the Blue Cross Blue Shield of Massachusetts Foundation.

“MassHealth took a really thoughtful, really thorough approach and really came at this intending to reduce the coverage loss as much as they could,” she said.

There remain questions it may take time to answer, though, she said. The biggest unknowns are details about the people who lost coverage due to a lack of information. The assumption is many obtained private insurance, but it’s unclear how many still are eligible for MassHealth or whether they’ve obtained sufficient insurance in its place.

“I think it’s going to be really, really important for us to track the state’s uninsurance rate going forward,” Howitt said.

Jason Laughlin can be reached at jason.laughlin@globe.com. Follow him @jasmlaughlin.