In May, the state completed a major 14-month effort to verify millions of residents' eligibility for MassHealth, the state's Medicaid program, for the first time since the pandemic began. During the public health emergency, federal law prohibited annual eligibility screening of Medicaid members to maximize coverage during the crisis. However, beginning in April 2023, states will be required to require members to reapply to the program.
As a result of the so-called redetermination, about 363,000 people were cut from MassHealth. At the time, state officials said about one-third of them were no longer eligible for services, and most of the rest did not respond to outreach or were uninsured because they appeared to have income that would make them ineligible for MassHealth. He said he lost it.
State officials say it won't be until the fall of 2025 that they will know exactly how many people are uninsured in Massachusetts and who they are. When U.S. Census data is expected to be released.
But according to recent data from the state; Health Information Analysis Center It suggests the redetermination may have caused the largest surge of uninsured residents the state has seen in the past decade: more than 130,000. few People's coverage of major health insurance companies, including most private insurance, Medicaid, and Medicare, has increased compared to the same period in 2023.
The CHIA count does not count people with some other forms of insurance, including the Veterans Administration and Federal Employee Benefits Programs, so it is not a complete tally of insured residents in Massachusetts. do not have. Health officials also noted that some people counted as uninsured in the report released in September and based on March data likely have become insured since then. did.
Documentation is often the biggest barrier to obtaining insurance. Massachusetts provides health insurance to people who are missing immigration documents, pay stubs, or social security cards and still qualify to receive insurance if they've lost it or don't have coverage through their employer. Insurance coverage for those eligible to participate in the Health Connector Marketplace may be hindered.
“This is a complicated maze for everyone,” said director of integration, clinical and operational excellence at East Boston Neighborhood Medical Center, which serves patients in the city and nearby areas including Chelsea, Revere and Winthrop. said Evonne Yang, assistant vice president. “At this peak [in the spring]The number of patients asking questions about insurance was about four times higher than usual. ”
Community health centers, which provide free primary care to people without insurance, often have staff on hand to help people eligible for MassHealth enroll in the program. Yang noted that demand for insurance assistance has decreased significantly in recent months.
MassHealth's membership has grown to nearly 2.4 million as of April 2023.
“For many patients, that was a great thing,” Jones said. “The fact that they managed to stay was great.”
The membership review for 2023 and this year allowed MassHealth to exclude beneficiaries who no longer qualify for the program. As of November, the number of members is approx. 2 million.
“lots of [the decrease] “Maybe it's because people have trouble navigating the renewal process or navigating new insurance coverage,” said Adrianna, assistant professor of health policy and political science at Harvard's T.H. Chan School of Public Health. Mr. McIntyre said. “This is due to both lack of information and the cost of effort.”
Experts and state officials predict a decline in coverage after the redetermination process, and officials with MassHealth, the state's Medicaid administrator, said they expect coverage to decline after the redetermination process. He praised the strong community-focused advocacy efforts.
“It appears to be working,” said Mike Levin, assistant secretary for MassHealth. “When you look at these communities, MassHealth has seen a small decline in enrollment.”
Health Care for All knocked on 400,000 doors across the state and led the effort through thousands of events and community partnerships. MassHealth still has about 260,000 more members than before the pandemic, Levine said.
“If you compare now to 2019, we're still seeing a fairly large shift to Medicaid,” he said.
CHIA reported a significant increase in the number of people covered by private insurance in March compared to June 2023, primarily due to former MassHealth members migrating to Connector. More than 192,000 people who lost MassHealth coverage enrolled in Connector between May 2023 and December of this year, according to communications director Jason Lefferts. The Insurance Marketplace currently has approximately 344,000 members, its largest enrollment to date.
Levine said MassHealth will continue to work with community partners to reach uninsured and Medicaid-eligible people, and will continue to work with the federal government in September, when states will have more clarity on the uninsured. They are looking forward to the survey data.
“I think we need to better understand who these people are and where they are on the path to health insurance,” Levine says.
Ultimately, McIntyre said, the U.S. health insurance infrastructure is fragmented, people are forced to change the type of insurance they use based on their employment, and a small number of people remain insured at least for a period of time. He said it was virtually certain that it would not be possible.
“The uninsured rate is stubborn,” she says. “This is about the rifts that occur when you ask people to move beyond coverage.”
Jason Laughlin can be reached at jason.Laughlin@globe.com. follow him @jasmLaughlin.
