Who is eligible
Children up to 1 year with household income up to 200% of FPL. Children ages 1-18 with household income up to 150% of FPL. Pregnant women with household income up to 200% of FPL. Adults with household income up to 133% of FPL.
- healthinsurance.org contributor
- September 26, 2016
It’s no surprise that Massachusetts has a robust Medicaid program, giving the commonwealth’s leadership in expanding health care coverage. Massachusetts has relatively high income limits for the groups it covered prior to the Affordable Care Act (ACA) rollout, and it adopted ACA Medicaid expansion to cover low-income adults in 2014.
However, the election of Republican Charlie Baker as governor could bring changes to MassHealth, as the Medicaid program is called. Baker says he would consider applying for federal waivers to enable to the commonwealth to “advocate for its own interests” relative to its Medicaid program. But as of late 2015, Baker’s primary focus with MassHealth has been verifying eligibility of currently-enrolled residents and making sure that people who were automatically enrolled in MassHealth in 2014 are removed from the Medicaid rolls once their eligibility for other coverage is determined.
MassHealth eligibility guidelines
MassHealth is more generous than many other Medicaid programs. Individuals qualify with incomes up to the following levels.
- Children up to age 1: 200 percent of the federal poverty level (FPL)
- Children ages 1 to 18: 150 percent of FPL
- Pregnant women are covered with family income up to 200 percent of FPL
- Children with family income too high to qualify for Medicaid and pregnant women who aren’t eligible for Medicaid due to immigration status are eligible for the Children’s Health Insurance Program (CHIP); CHIP is available to kids with family income up to 300 percent of FPL and to non-resident pregnant women with income up to 200 percent of FPL
- Parents and other adults are covered with incomes up to 133 percent of FPL
See FPL stated as dollar amounts at Medicaid.gov.
How you can sign up
- Submit an application online at MAhealthconnector.org.
- Fill out a paper application. Return your completed form:
- By mail: Health Insurance Processing Center; P.O. Box 4405; Taunton, MA 02780.
- By fax to 617-887-8770. Use this cover sheet when faxing your application.
- Apply by phone by calling 1-800-841-2900 or TTY: 1-80te0-497-4648 for people who are deaf, hard of hearing, or speech disabled.
- Apply in person at a MassHealth Enrollment Center. See the left side of this webpage for a list of centers or call 1-888-665-9993 (or TTY: 1-888-665-9997 for people who are deaf, hard of hearing, or speech disabled).
Former Gov. Deval Patrick signed the legislation authorizing Medicaid expansion in July 2013.
Under the expanded Medicaid eligibility guidelines, 32 percent of uninsured residents of Massachusetts were eligible for either Medicaid or CHIP as of 2015.
While Gov. Charlie Baker has mentioned seeking a federal waiver to modify the commonwealth’s Medicaid program, he has not specifically called for rolling back Medicaid expansion. So far, Baker has mentioned a waiver to increase pay for primary-care doctors and vaguely referred to other approaches that might work in the commonwealth’s interests. His primary focus has been on eligibility verification to make sure the state isn’t covering people who aren’t actually eligible for MassHealth benefits.
Temporary MassHealth enrollment in 2014
The Massachusetts Health Connector is a state-run exchange that pre-dates the ACA. But the process of making it compliant with the ACA proved to be technologically challenging; the system was supposed to screen applicants to determine whether they were eligible for MassHealth or premium subsidies, but wasn’t functional in its first year. As a result, about 325,000 applicants were temporarily enrolled in MassHealth in 2014. This allowed those residents to have health insurance despite the exchange glitches, but it also cost the state about $140 million in 2014.
By the end of January 2015, about 130,000 people who had been temporarily placed on MassHealth in 2014 had been able to verify their eligibility for coverage through Massachusetts Health Connector. Roughly half of them were actually eligible for MassHealth and remained covered under the program (the rest were able to transition to private plans instead, with subsidies if eligible based on household income).
Eligibility verifications in 2015
When Governor Baker unveiled his budget in March 2015, one of the primary focuses was on reducing Medicaid spending. That included verifying eligibility for 1.2 million of MassHealth’s 1.9 million enrollees (the other 700,000 had enrolled recently enough that their eligibility was current). Federal Medicaid rules require that enrollees’ eligibility be verified annually, but the technology problems with the Massachusetts Health Connector in 2013 – 2014 resulted in MassHealth coverage being automatically renewed for 1.2 million people without verifying eligibility.
Enrollees had to update their information in order to renew their benefits, and by May 2015, the program had disenrolled 158,000 people – out of 500,000 – who hadn’t responded to the state’s information requests. The state began combing through the next round of 500,000 enrollees in July, making sure that they’re still eligible to remain on MassHealth. By September, the eligibility verification process had reduced total MassHealth enrollment by about 205,000 people.
Between September 2013 (just prior to the first ACA open enrollment period) and August 2015, MassHealth enrollment has grown by 27 percent. As of August 2015, total enrollment stood at 1,641,784.
Increased costs associated with the MassHealth enrollment spike is cited as the biggest factor in the commonwealth’s budget deficit. About $230 million of a total gap of $765 million in the fiscal budget is attributable to MassHealth, according to the Baker administration. And MassHealth costs were the primary factor that contributed to Massachusetts spending $632 million more on health care in 2014 than their pre-determined spending target. But again, some of that had to do with people being temporarily enrolled in MassHealth due to Connector problems, and the automatic re-enrollment of 1.2 million people also contributed to the increased spending, but has been addressed in 2015.
Governor Baker’s FY 2016 budget included $15.3 billion in MassHealth spending, which is a 5.6 percent increase over FY 2015 spending. But without changes to the program (like the eligibility redeterminations), MassHealth spending was projected to increase by 16 percent, to $16.9 billion.