Enrolling eligible Commonwealth residents in high-quality, subsidized (Commonwealth Care) insurance plans has been a major thrust of our first-year health reform efforts.
In addition, the push has been to increase MassHealth enrollment based on new “expansion populations” (the largest of these being kids who are now eligible up to 300 percent of the FPL).
Before the launch of health care reform, an estimated 372,000 Massachusetts residents had no health insurance. Today, more than 120,000 residents have insurance as a result of reform. Getting qualified residents coverage is only part of our challenge. We must also ensure they stay covered as long as they remain qualified.
The unfortunate reality is many qualified individuals end up without health insurance coverage for segments of time. This phenomenon – one aspect of “Medicaid churn” – ultimately is not about a recipient’s loss of Medicaid eligibility.
A recent analysis of Network Health’s MassHealth membership shows that 58 percent of people who were involuntarily disenrolled (code for kicked off the Medicaid rolls) were subsequently re-enrolled in MassHealth. Of those who re-enrolled, 70 percent did so within 90 days. Most were involuntarily disenrolled due to administrative issues such as returned mail (if a MassHealth mailing is returned because a member is no longer at the address on record, that member can be disenrolled. So, if an enrollee moved from an apartment to a shelter, he/she would be dis-enrolled)
Clearly, this data shows that the vast majority of re-enrollments happen within a short time and therefore that we (MassHeatlh really) have an opportunity to avoid thousands upon thousands of gaps in coverage every month. With new rules afoot to give MassHealth members only 45 instead of 60 days’ notice of their renewal dates, disenrollment rates are only likely to increase and with them the volume and length of coverage gaps.
As the new Safety Net Trust Fund (Pool) regulations are issued, which limit eligibility for free care services, the problem becomes one that we can’t ignore. More and more, we will have hospitals, health centers and low-income families left holding the bag during coverage gaps since these members would be deemed ineligible for pool coverage since they were “eligible” but not enrolled for MassHealth. We don’t want to find ourselves making progress at the front door and losing those gains through the back door- which is what we have right now- five steps forward, three steps back.
Presently, the gap represents a lose-lose situation for MassHealth members and providers. Members lose coverage and access to key preventive care; providers must choose between providing truly “uncompensated” care or no care. The gap also generates tremendous costs for the state due to the administrative burden associated with member churn.
The answer to continuity of coverage conundrum, if there is one, might be found in the potential savings that would be realized by reducing the churn. I’m not sure if anyone’s ever study this (eg: Massachusetts Medicaid Policy Institute). This is a very important issue and one that is very contemporaneous given this issuance of the new Safety Net Regulations. It is also an issue that is very germane to the principles goals of Chapter 58- that of getting, and keeping, all Massachusetts residents insured.
Christina Severin is executive director of Network Health, a health plan with more than 135,000 low- and moderate-income members with state-subsidize health insurance across Massachusetts.
The new eligibility rules for the Safety Net Trust Fund are a very big step backward for universal access to care. The “churn” that Christina Severin describes is a very real thing. People who depend on the safety net for health care tend to be in a state of continual change with regard to their job and where they live, and as a result many wind up going from place to place with different insurances – they have a job that has insurance, they leave it or get laid off, they wind up uninsured until they need to go to a doctor, at which point they wind up in a different system. With Chapter 58, you can add failing to pay premiums to Commonwealth Care to the mix of reasons why they won’t have insurance when they arrive at their clinics. The Free Care Pool was the safety net that meant that their provider had access to some form of reimbursement. With the new rules, patients will be punished if they continue their churn, winding up with nothing except bills (or their providers of care will wind up with much more bad debt), and re-learning what people in their circumstances learned before there was a free care pool – that the only place that has to take you is the emergency room. This is not progress.
[...] or fails to re-enroll in the system when it “churns” them out (see Christina Severin’s blog on churning). Failure to pay or re-enroll will result in you getting tossed out of health insurance. In the [...]