Update on the Massachusetts Medicaid Redetermination Process

MassHealth is pursuing a multi-pronged approach to reducing coverage loss during the Medicaid redetermination process, an issue brief from Manatt Health explained.

The researchers noted that MassHealth enrollment swelled by 25.4 percent from February 2020 through January 2023. They attributed the 2.35 million enrollee total in part to the continuous coverage requirement.

“MassHealth has developed and is deploying a multiprong plan to increase outreach to members,” the researchers stated.

“As part of its plan, MassHealth is working with key partners, including community-based organizations and managed care plans, to prepare for the end of the federal continuous coverage requirement and get the word out about the importance of updating eligibility information and responding to requests for information related to redeterminations.”

MassHealth’s first step in redetermination is to confirm an individual’s eligibility based on the information that is already accessible, an “ex-parte renewal.” The alternative is to request eligibility information from beneficiaries by mailing them a paper renewal form which must be completed within a certain timeframe. The program has been conducting ex-parte renewals throughout the pandemic.

The Massachusetts Medicaid program will take 12 months to process eligibility redeterminations, along with at least 42 other states. CMS offered an extended timeframe to reduce the likelihood of errors due to rushed processes. MassHealth will start with the oldest eligibility redeterminations cases and will take a population-based approach to its renewals.

MassHealth will first approach for renewals any populations that were unable to complete an ex-parte renewal due to missing data as well as those who were determined ineligible for Medicaid through an ex-parte redetermination process during the continuous coverage period.

MassHealth sought to simplify the ex-parte renewal process by widening the acceptable threshold of difference between a person’s reported income and income data.

The state has also used federal funding to amplify its community-based outreach and redetermination education efforts. The Medicaid program is working with a nonprofit called Health Care For All (HCFA) Massachusetts.

Together, HFCA Massachusetts and MassHealth plan to connect with local organizations that can support outreach efforts, kick off media campaigns tailored to specific ethnic communities, canvass communities at high risk of widespread coverage loss, and educate health plans and stakeholders about communicating with beneficiaries. The partners will also invest in expanding the Certified Application Assisters (CACs) population.

In addition to its partnership with HCFA Massachusetts, MassHealth is working with the National Change of Address (NCOA) to confirm enrollee information. The program will give access to a public dashboard that displays the number of redeterminations and terminations. The dashboard will also offer top reasons for termination.

MassHealth has met individually with managed care plans and other stakeholders to educate them about the post-coronavirus redetermination process. Health plans have certain obligations to fulfill as a part of the redetermination process, particularly by spurring members to update their information.

The Medicaid program changed its call center script and social media strategy to encourage members to update their information. Five populations take priority in MassHealth’s outreach plans: individuals 65 years old or older, homeless beneficiaries, enrollees with disabilities, refugee or immigrant enrollees, and children and families.

Disenrolled individuals who are eligible for qualified health plans and ConnectorCare may receive communications from the state health insurance marketplace urging them to transition to the Affordable Care Act marketplace.

Additionally, MassHealth expanded its workforce to accommodate the complex process. For example, the program added 35 call center staff members.

Massachusetts Medicaid beneficiaries most at risk of being improperly disenrolled include individuals who do not show up in data sources used for verifying eligibility and those who, for any reason, cannot receive or reply to Medicaid communications about updating eligibility information. Homeless individuals who often change living situations are also at risk of improper disenrollment.

Additionally, individuals who are ineligible for Medicaid could become uninsured even though they might be eligible for affordable coverage through the state health insurance marketplace.

Higher enrollment means that returned mail is more likely and that many beneficiaries may be unfamiliar with the redetermination process. These factors could contribute to unnecessary coverage loss, particularly among minority populations who were hit hard by the coronavirus pandemic’s economic and health impacts and by socioeconomic shifts in general.

“Given the potential for significant coverage loss and widened inequities as the Medicaid continuous coverage requirement ends, it is critical for states and health care stakeholders to use all the tools at their disposal to ensure that people who remain eligible stay covered,” the issue brief concluded.