MassHealth guarantees coverage at Medicaid redetermination

MassHealth, the Medicaid program in Massachusetts, experienced a substantial increase in enrollment during the COVID-19 pandemic.

MassHealth reached a total of 2.35 million enrollees by January 2023.

However, given that the federal continuous coverage requirement ended last April 1, 2023, MassHealth faces the challenge of ensuring a smooth and efficient redetermination process to avoid loss of coverage for eligible beneficiaries.

MassHealth has developed a comprehensive, multi-pronged approach to increase outreach, education and support for its members throughout the redetermination process.

MassHealth and its collaboration with stakeholders:

To ensure effective outreach, MassHealth is working closely with community organizations and care plans to mitigate the impact of the termination of the federal continuous coverage requirement.

It also seeks to disseminate information about the importance of updating eligibility details and responding to redetermination requests.

MassHealth ensuring health

Simplifying the redetermination process:

MassHealth’s initial step in the redetermination process is to confirm an individual’s eligibility based on information already accessible: an “ex-parte renewal” as it is known in English or out-of-time renewal.

Alternatively, the program may request eligibility information from beneficiaries by sending them a paper renewal form to complete within a specified time frame.

Adoption of an extended redetermination period:

MassHealth, along with at least 42 other states, will take 12 months to process eligibility redeterminations.

This extended timeframe, offered by the Centers for Medicare and Medicaid Services (CMS), reduces the likelihood of errors resulting from rushed processing by prioritizing older eligibility redeterminations.

MassHealth: Targeting Specific Populations

MassHealth plans to initiate renewals with those who were unable to complete an ex-parte renewal due to missing data or who are deemed ineligible for Medicaid.

It will do this through an ex-parte redetermination process during the period of continuous coverage.

The program is intended to ensure that eligible individuals remain covered.

Prioritizing outreach to vulnerable populations:

MassHealth prioritizes outreach to five groups: individuals age 65 and older, homeless beneficiaries, enrollees with disabilities, refugee or immigrant enrollees, and children and families.

The program’s multi-pronged approach to reducing loss of coverage during the Medicaid redetermination process demonstrates its commitment to ensuring smooth transitions for its members.

By collaborating with key stakeholders, leveraging technology, and prioritizing outreach to vulnerable populations, MassHealth aims to mitigate the risk of inappropriate disenrollment and unnecessary loss of coverage.

As the federal requirement for continuous coverage ends, this organization’s proactive efforts are critical to maintaining coverage for eligible beneficiaries and addressing potential disparities.

Especially among minority populations affected by the health and economic impacts of the pandemic.

Blue Envelope

During the eligibility redetermination process, MassHealth will send all renewals to enrollees in a blue envelope (pictured below).

In each blue envelope, members will find the following:

  • Your renewal notice, including the renewal deadline date,
  • A brochure about your renewal, and
  • The printed Renewal Form.

It is important that members not only read it, but also respond to it in order to maintain their coverage and understand the benefits to which they are entitled.

They will receive this other correspondence in white envelopes separate from the blue envelope with the renewal documents.

The return address may be “Commonwealth of Massachusetts” or a specific Massachusetts state office, such as the Health Insurance Processing Center or EDMC.

Members should be alert to receiving mail that may be from MassHealth and should open the envelopes.

Respond to MassHealth by the deadline

Your notice will include a deadline. Be sure to complete all the necessary information and send it to MassHealth by the deadline.

You may qualify for an affordable plan through the MA Health Connector. Remember to visit the MA Health Connector table on our website.

Members can visit or call Customer Service at 1-877-623-7773 (1-877-MA ENROLL) for more information or to enroll in a plan.

If you lose your MassHealth coverage, this would be a Qualifying Life Event (QLE). This means you can enroll in a plan through the Health Connector outside of the regular Open Enrollment Period.

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