Earlier this week, the Massachusetts Medicaid Policy Institute released a superb report, “Enrollment and Disenrollment in MassHealth and Commonwealth Care.” Bob Seifert, from the UMass Center for Health Law and Economics is the lead author. Bob’s Commonhealth blog post does a good job of summarizing, as does the report’s executive summary.
Bottom line: “A sizable number of people are unable to maintain their coverage over a period of time, despite remaining eligible for the program….The consequences for those who encounter even a temporary loss of their health insurance coverage are extensive, significant, and often detrimental.”
For those of us who work with MassHealth and Commonwealth Care, the report tells us what we know – just with real numbers and excellent detail. Lots of folks fall off of coverage and fall off often; gaps in coverage are expensive and negatively impact health status; and much of the “churn” that occurs for administrative reasons can be prevented.
We hear from thousands of confused and frustrated HelpLine callers every year that are affected by churn. Folks often times call us after they have show up for their doctor’s visit or go to pick up a prescription and are told that they are uncovered. It can take weeks for these glitches to be resolved. In situations like these, people are usually required to pay out-of-pocket for their care. This leaves the family unable to access the health care services that they depend on until they sort out the mix-up.
Bob analyzed data from both health programs for 2008 and 2009, looking to understand how many people are disenrolled and then re-enrolled in a program within three months. If there is churn in this 90 day window, it’s likely that the disenrollment was caused by an error (on either the State’s or the enrollee’s side), not a status or eligibility change. On average, over 12,000 people per month fall into this category – at a admin cost to the state of $200 per enrollee, per enrollment cycle. That’s $28,800,000. (In case you’re stumped, we have some thoughts on what we could do with that money.)
Now some of this disenrollment and enrollment will always happen—people get lost, don’t do what they’re supposed to. The Feds make demands of the state requiring eligibility checks. But there are also plenty of pieces of churn that are avoidable and that we should fix, on both the MassHealth and the Commonwealth Care sides of things. What kind of churning we can eliminate through administrative fixes? How can we reduce volatility in the MassHealth and Commonwealth Care caseloads?
Here’s what’s exciting; MassHealth is working hard on some fixes to the problems. The report talks about the state’s grant from the Robert Wood Johnson Foundation, “Maximizing Enrollment for Kids,” that focuses on improving administrative processes and improving retention. Through the grant, MassHealth’s Chief Operating Officer Phil Poley conducted a diagnostic assessment of their data use, capacity, and customer service and found areas of improvement to focus on:
- Administrative renewals (pre-printed forms that require a response only if there is a change in eligibility): MassHealth has already started this with some nursing home patients (see our blog post) and is now trying to understand what other populations they could expand to.
- Ex-parte renewals (fancy way of saying using other sources of information – DOR, Food Stamps – to make determinations): this promotes collaboration between various state agencies, saving time, money, and personnel resources.
- Centralized electronic document management (EDM, your new acronym of the day): a chunk of enrollment volatility is due to misplaced or delayed forms. MassHealth is starting an EDM pilot later this year that they plan to expand into next year.
- 12-month continuous eligibility: the state is looking for financial models to understand better what this would look like.
MassHealth will be hosting its first annual statewide stakeholder meeting on June 10th, at the UMass’ Hoagland-Pincus Conference Center, for walk through the grant, explanation of the diagnostic assessment, and discussion. (Invitations out through MTF soon.)
Two policy pieces that Health Care For All, the ACT!! Coalition and the Children’s Health Access Coalition (CHAC) have been working on will prevent additional churn and gaps in coverage. ACT!! would like to see Commonwealth Care use the MassHealth model of starting enrollment on the date of application,as called for in our bill now pending before the Health Care Financing Committee (see fact sheet).
And CHAC is focusing on 12-month eligibility for kids, an option encouraged by federal law but not implemented in Massachusetts. Last night, the House approved a budget amendment by Rep. Ellen Story establishing 12-month eligibility. This is good for families, for providers who won’t have to worry about patients cycling on and off, and for the state, through lower administrative costs. We thank Rep. Story for her outstanding advocacy and look for a similar provision in the Senate.
The report’s worth a read. So is thinking about these issues and dialoging on how to fix them. Thanks to Bob and MMPI for the research and to Phil and MassHealth for moving us forward. Innovative policies that reduce churn are good for consumers and good for the state.