Update on MA Health Reform

Sarah Iselin, President of the MA Blue Cross Blue Shield Foundation, sent along a copy of a new report entitled, "Enrollment and Disenrollment in MassHealth and Commonwealth Care." It was prepared for the Massachusetts Medicaid Policy Institute by Robert Seifert, Garrett Kirk, and Margaret Oakes. Neither an indictment nor a congratulatory document, it is a thoughtful and useful report on a particular aspect of the MA health reform experiment.

Here's the link.

From the Executive summary:

Massachusetts has made great strides in making health insurance attainable for nearly all of its residents, and the state’s main public coverage programs — MassHealth and Commonwealth Care — have been a significant component of this achievement. Beyond getting coverage, though, it is necessary to maintain coverage, because continuity of coverage is an important element of access to care, particularly among those with frequent medical needs.

Evidence from MassHealth and CommCare, and from Medicaid and CHIP programs in other states, suggests that a sizable number of people are unable to maintain their coverage over a period of time, despite remaining eligible for the program. There are a number of reasons for this enrollment volatility, including:

--an enrollee’s income has increased or they have gained access to employer-sponsored insurance;
--an enrollee does not want to or is unable to pay required premium contributions; or
--an enrollee fails to return paperwork or provide other necessary documentation of their eligibility, in some cases because MassHealth does not have a current address for them.

Of those who are disenrolled, some will come back to the program at a future date and requalify for benefits, while others will transition to another public program, private coverage or uninsured status. If an individual returns to the program after a short time, it is often because the initial disenrollment was due to a failure to return paperwork, provide adequate documentation of income or employment status, or some other reason unrelated to conditions of financial eligibility. These administrative closings followed by swift reopenings — sometimes called “churning” — can disrupt people’s access to health care.

Not all movement on and off of programs is churning: some enrollment and disenrollment is a natural and legitimate consequence of a program where eligibility is based on income and employment circumstances that are subject to frequent change.....