State Auditor: MassHealth Needs Better Checks On Income, Residency

Mass. state auditor Suzanne Bump

WBUR’s news staff reports on findings released today by state auditor Suzanne Bump. She found shortcomings in the state’s $12-billion MassHealth program, the government insurance for lower-income residents:

State auditor Suzanne Bump is auditing the MassHealth program, saying it lacks safety measures to verify applicants’ income, or that they live in Massachusetts.

The audit says MassHealth, which provides care to low-income residents, cost the state $6.5 million in 2010 alone by treating patients who may have lived outside Massachusetts. It also does not verify an applicant’s supplemental income, such as lottery winnings.

And State House News reports:

Income verification shortcomings in the state’s massive MassHealth program make it possible for ineligible applicants to receive health insurance benefits for a year before being removed from the program, according to an audit released Wednesday.

According to Auditor Suzanne Bump, MassHealth’s first verification of an applicant’s self-reported earned income occurs a year after applicants are enrolled and receiving benefits.  Bump also reported that MassHealth does not verify information about unearned income of applicants, or resources derived from lottery winnings, for instance, or stock dividends, pension payments or rental income.  While Bump did not conclude that the procedures are leading to benefits being awarded to ineligible individuals, she said her audit results show the need for improvements in the verification process and may be costing the state millions of dollars a year.

At a cost of about $12 billion per year, about a third of the state budget, MassHealth provides health insurance coverage and access to services for about 1.3 million low and moderate-income individuals in Massachusetts.   Bump also concluded “thousands” of individuals who are not residents of Massachusetts may be receiving MassHealth benefits inappropriately because MassHealth does not have a process to effectively verify the state residency of applicants and only verifies residency in cases where conflicts are found in applications.

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  • Julie M. (Sudbury)

    Well, while it is imperative that Mass Health Reviews eligibility on a regular basis – there is another side of the coin here. I know a young man who is very sick, suffering from dizziness, nausea, migraines and PTSD and is in the middle of treatments and diagnoses. It took Mass Health 6 months to assign him a doctor – then another 3 months for him to be seen by that doctor. Now, in the middle of treatments and medication adjustments – he managed to miss a letter requiring some documentation – and they have cut his insurance! I am wondering what he is supposed to do and how far back this will set him in his recovery – and how long it will take to get him reinstated.
    There ought to be an electronic flag to the schedulers of appointments to let people know when there is an impending termination of insurance.

  • John Getsinger, Esq. (Acton)

    The State Auditor in her report is advocating only one
    simple measure, more electronic surveillance for more denials, as her preferred
    way to save taxpayer money. Brrr! That’s cold. It seems to me her report should
    not have so strenuously avoided the more serious question of how to get the
    system to work better with less confusion and less cost, not just to the
    Commonwealth, but to applicants, families, providers, and their advocates – to
    say nothing of the public whose taxes will ultimately have to pay the
    incredible cost of dealing with catastrophic health conditions resulting from
    the undue denial of timely care. As an attorney and patient advocate, I never
    thought you’d be hearing me say this, but on this one the MassHealth people
    really have it right, you have to balance the costs of über-compliance against
    the total value to the public. Unless you’re just pushing some fringe political
    agenda . . . .

  • james

    what a sense of priorities….

    $6.5 million of $12 billion may be being spent on healthcare people who do not qualify…..

    is that the biggest problem she found?