State's version of Medicaid is redetermining the eligibility of every member

As MassHealth redetermines eligibility for its members throughout the state, local hospitals and community care centers are working to inform and educate the public about the renewal process.

MassHealth, Massachusetts' version of the Medicaid program, implemented continuous coverage protections in response to COVID-19. But the federal emergency is scheduled to end later this spring, which will halt continuous Medicaid enrollment on Friday and begin the process of rechecking the eligibility of every member.

MassHealth membership has grown from 1.8 million to 2.3 million since the start of the pandemic three years ago. Earlier this month, Gov. Maura Healey estimated that about 400,000 people will lose benefits due to eligibility reassessment, freeing up $1.9 billion in fiscal 2024 for state spending. According to Healey’s proposed supplemental budget, $3.5 million will be used to support the redetermination process.

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Vicker DiGravio, president of Riverside Community Care, said the Milford location served about 1,400 individuals with MassHealth in 2022, about 70% of its total patients. Riverside operated a traditional outpatient center at its West Street site in Milford prior to opening a community behavioral health center there in January.

"We are alerting staff in our program that the individuals they're working with may be getting letters regarding a redetermination, and we've asked them to be on alert and to be available to help individuals with that process," DiGravio said, adding the renewal process can be "impactful" based on how many MassHealth patients become ineligible.

Tricia Oliver, vice president for public relations, marketing and communications at Milford Regional Medical Center, said in an email that the center doesn’t anticipate a drastic change in demand based on MassHealth’s redetermination because insurance status is not a driver of the need for services.

"In light of MassHealth’s exercise, we are and will continue to communicate to our MassHealth patients that they need to update their information with MassHealth, look for the blue envelope in their mailboxes, and respond to the mailing by the relevant deadlines," Oliver wrote. "Milford Regional also has existing, on-site counselors who can assist patients with the MassHealth application."

MassHealth members must renew coverage

Starting April 1, all current MassHealth members must renew their coverage over 12 months. Residents can expect to receive a blue envelope that includes a form for them to respond to and return within 45 days, or face losing current benefits.

"It's basically to allow them to update their information and update their household income and any other circumstances that may have changed to see if they still qualify for MassHealth or what they're qualified for if they do not," said Hannah Frigand, director of education and enrollment services at Health Care For All.

If the agency requires additional information, members will have additional 90 days to provide it. Before losing coverage, members have another 14 days to submit the necessary information or be declared ineligible.

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Frigand said the length of renewal forms will differ for different populations — members over 65 will not receive a form that contains information already filled in.

"There's a shorter renewal form," she said. "It's about 10 pages for a lot of people who live in the community. But then there is a longer form for people who might be living in a nursing home or have other circumstances where they might need to fill out more information about their household or their circumstances."

DiGravio said Riverside will work to connect individuals with a provider that the center has contracted with if their MassHealth benefits are lost.

"We hope that it's minimal impact and minimal disruption to people's care," he said. "But until the process plays out, we don't have any real insight or any way to gauge that."

Oliver said Milford Regional remains committed to serving all patients, regardless of the number affected.

"For any patient who is uninsured, we guide them to apply for coverage through the Health Connector," she wrote in her email. The Health Connector aims to offer affordable health plans for people who lost their insurance.

Health Connector a 'landing spot'

Health Connector Executive Director Audrey Morse Gasteier said she is expecting up to 200,000 new enrollees this year.

"For many people, we will be the natural kind of landing spot for people who lose MassHealth eligibility," she said. Those who lose eligibility may qualify for coverage through their employers, but for those who are losing their health coverage, she added, "the Connector is the right place for them from a coverage perspective, and we'll be able to offer affordable coverage options as they transition to new coverage."

Gasteier also said the "integrated eligibility system" shared between MassHealth and the Health Connector will ensure that when someone loses MassHealth, they automatically become eligible for assistance from the Health Connector.

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"Once that happens for people, they'll start hearing from the Health Connector directly. We'll be reaching out with mail, email, text and outbound calls," she said.

MassHealth will use its regular, proven process with new enhancements to streamline the redetermination process further, but it will be different due to the high volume of renewals and low awareness among members, according to the Executive Office of Health and Human Services. 

Gasteier added Health Connector has prepared for an increased volume of needs by enhancing the outreach and communications capacity.

"We have an increased capacity in our call centers and in our Navigator Program, which is a network of community-based organizations trained and certified to provide enrollment assistance to people in a variety of languages," she said.

A $5 million outreach and education campaign has been launched by HCFA in partnership with MassHealth, the Massachusetts Health Connector, community groups and health care providers — including door-to-door canvassing in 15 municipalities, including Boston, Brockton, Chelsea, Everett, Fall River, Framingham, Lawrence, Lowell, Lynn, Malden, New Bedford, Quincy, Revere, Springfield and Worcester.

'Knocking on every door'

"There are 1.3 million MassHealth members in those communities," Frigand said. "We're hoping that we can reach out to as many as possible. We'll be using census data to door knocking on every door that's accessible in those neighborhoods. We're trying to get to people where they are and just raise awareness."

According to Laura Giordano, an account executive at Melwood Global, which partners with HCFA, the number of MassHealth enrollees will decrease, but not because their health insurance coverage will be lost.

"It's because they're getting matched with a program that's a better fit for their current circumstances," she said. "That is part of what the wonderful helpline counselors at Health Care For All and all across the state in partnership with MassHealth are working to help people do is to make sure that they receive health insurance coverage to fit their current needs, regardless of what that may be."

As the state requires all adults to carry health insurance, Gasteier said it’s important for people to take action.

"If they do miss a window, we'll provide support and make sure they get into coverage because we don't want people going without health insurance here in Massachusetts," she said.

This article originally appeared on The Milford Daily News: MassHealth redetermines member eligibility as COVID danger ends