Study Finds MassHealth’s Enhanced Eligibility Verification Saves $250 Million a Year

Share on Facebook
Share on Twitter
Share on
LinkedIn
+

Reforms fixed MassHealth’s $1.2 billion eligibility crisis, freed up money to be redirected to needy recipients

BOSTON – Enhanced eligibility verification allowed MassHealth, the Commonwealth’s Medicaid program, to save significant resources that could be redirected to the care of truly needy Medicaid recipients, according to a new study published by Pioneer Institute.

“MassHealth’s success at digging out of an eligibility crisis that cost Massachusetts at least $658 million, according to the Commonwealth’s Health Policy Commission, holds important Medicaid eligibility lessons for other states,” said Dr. William J. Oliver, author of “MassHealth Protecting Medicaid Resources for the Most Vulnerable: How Massachusetts Saved Hundreds of Millions through Enhanced Eligibility Verification.”

After the failure of initial efforts to comply with Affordable Care Act rules that required the Commonwealth to change its eligibility systems, then-Gov. Deval Patrick obtained permission to suspend mandatory annual eligibility redeterminations and extend temporary Medicaid coverage to anybody who signed up, regardless of income.

In 2014, Medicaid operated for five months without any eligibility determinations, during which time 321,000 new beneficiaries were added, expanding MassHealth enrollment to more than two million or roughly 30 percent of the state’s population. Gov. Charlie Baker ended temporary coverage and MassHealth phased in enhanced eligibility measures to stabilize the program.

MassHealth began by conducting 1.2 million manual eligibility redeterminations over five months.

Beginning in October 2016, MassHealth tested a series of new eligibility matches to improve accuracy. At the end of 2016 and into 2017, MassHealth tested and then implemented additional external data matches such as new hire and earnings data and death registry information to further refine eligibility determinations.

In total more than $1.2 billion was saved. Most of the savings came from ending temporary coverage for those who did not qualify for MassHealth, but $250 million resulted from enhanced eligibility checks through automated matches.

One key to MassHealth’s eligibility redetermination success was testing new automated matches in batch mode before rolling them out systemwide.

“Additional automated data check opportunities hold the promise of further improving the eligibility redetermination process,” said Josh Archambault, a senior fellow at Pioneer.  “They include enhanced checks to verify residency, sharing eligibility information with public assistance programs, and using asset verification checks for more populations to signal changes in income that could impact Medicaid eligibility.”

About the Authors

Dr. William J. Oliver has transformed benefits eligibility sys­tems and processes in Texas, Florida, Indiana, Pennsylvania, Mississippi and Arkansas. He has outsourced, insourced, and retooled eligibility systems for both Medicaid and human ser­vices benefits. Dr. Oliver has built, selected, and implemented leading-edge systems in hospitals, pharmacy, retail, and oth­er industries, and has driven major benefits eligibility reform including the Mississippi Hope Bill. He is a CPA and holds a Masters in Management from MIT and a doctorate in Man­agement from Case Western. Dr. Oliver is a Principal at The Stephen Group and is published widely on healthcare business model innovation and assessing program outcomes.

Josh Archambault is a Senior Fellow at Pioneer Institute. Pri­or to joining Pioneer, Josh was selected as a Health Policy Fel­low at the Heritage Foundation in Washington, D.C. In the past, Josh served as a Legislative Director in the Massachu­setts State Senate and as Senior Legislative Aide in the Gov­ernor’s Office of Legislative Affairs. His work has appeared or been cited in outlets such as USA TodayWall Street JournalThe New York TimesFox NewsNPRBoston Herald and The Boston Globe. He is the editor and coauthor of The Great Exper­iment: The States, The Feds, and Your Healthcare. Josh holds a Master’s in Public Policy from Harvard University’s Kenne­dy School and a BA in Political Studies and Economics from Gordon College.

About Pioneer

Pioneer Institute is an independent, non-partisan, privately funded research organization that seeks to improve the quality of life in Massachusetts through civic discourse and intellectually rigorous, data-driven public policy solutions based on free market principles, individual liberty and responsibility, and the ideal of effective, limited and accountable government.

Get Updates On Our Healthcare Research and Events!

Related Posts:

Pioneer Institute Statement on the Commonwealth’s Discontinuance of the COVID-19 Weekly Public Health Report

Useful information about COVID cases or deaths at individual homes has become less available at a time when cases are increasing again, even among vaccinated residents. Pioneer urges Massachusetts to immediately reinstate the so-called Weekly Report, which contains cases and deaths inside individual nursing homes.

Study: Massachusetts Should Retain Additional Healthcare System Flexibility Granted During Pandemic

Massachusetts’ emergency declaration for COVID-19 ends on June 15, and with it some enhanced flexibility that has been allowed in the healthcare system.  Some of the added flexibility highlighted barriers that make the system more expensive, harder to access and less patient-centered, and the Commonwealth should consider permanently removing these barriers, according to a new study published by Pioneer Institute.

Study Calls for Better Reporting on Impact of COVID-19 in Eldercare Facilities

Over time, the Massachusetts Executive Office of Health and Human Services and Department of Public Health (DPH) have improved reporting about cases and deaths from COVID-19 in state-regulated eldercare facilities, but flaws and omissions remain and should be corrected, according to a new study published by Pioneer Institute.

New Analysis: ICER Framework Ignores Patient Preferences, Innovation & Societal Benefits in Evaluating Cost-Effectiveness of New Cancer Treatments

Pioneer Institute today released a new analysis, The QALY and Cancer Treatments: An Ill-Advised Match, that examines the alarming methodological and contextual shortcomings of the Quality Adjusted Life Years (QALY)-based methodology in evaluating new cancer therapies. The Pioneer Institute analysis reveals five specific problems with ICER’s evaluation of cancer treatments and demonstrates the urgent need to prohibit the use of the QALY amid trends in rapid cancer innovations and personalized medicine.

Study: Massachusetts Should Embrace Direct Healthcare Options

Especially in the COVID era, many are looking to alleviate the increased burden on the healthcare system.  One solution is direct healthcare (DHC), which can provide more patient-centered care at affordable prices and is an effective model to increase access to care for the uninsured, underinsured and those on public programs like Medicaid, according to a new study published by Pioneer Institute.

Survey: Consumers Want Healthcare Price Information, But Few Realize It’s Available

Great strides have been made to increase healthcare price transparency through online cost estimator tools and a state law that requires providers to give out price information. Yet despite the eagerness of consumers to access prices and out-of-pocket costs, many are unaware that such information is available and don’t know how to access it, according to survey results published by Pioneer Institute.

Study: Growth of Antibiotic-Resistant Infections Could Have Massive Human, Financial Costs

The world was blindsided by COVID-19, but a new Pioneer Institute study finds that even as we continue to wrestle with the pandemic, another threat looms that scientists have long known about but the nation has thus far failed to address: the growth of antibiotic-resistant infections. “Market dysfunction and perverse Medicare reimbursement rates have led to a growth in infections that resist antibiotics,” said Gunnar Esiason, author of “Antimicrobial Resistance: Learning from the current global health crisis to prevent another one.”  If we don’t solve this problem, the human and economic costs are likely to be astronomical.”

Study: Growing Drug Rebates Hurt Both Consumers and Healthcare System

Ever-larger rebates are distorting the market for branded drugs and producing outcomes that often benefit neither consumers nor the healthcare system, according to a new study published by Pioneer Institute.

Study: Shift from Highest-Priced Healthcare Providers Would Generate Tremendous Savings

Consumers in just one Massachusetts county could have saved nearly $22 million in a single year and $116.6 million adjusted for inflation over four years if they switched from using the most expensive providers for 16 shoppable healthcare services to those whose prices were closer to average, according to a new study published by Pioneer Institute.

Pioneer Urges Future COVID-19 Study and Recommendations Task Force to Consider Impact on Nursing Home Residents

After over 5,000 people have died of COVID-19 in Massachusetts nursing homes, Pioneer Institute is issuing an open letter to the state’s future COVID-19 health equity task force that outlines an extensive list of recommendations on infection control and preparedness in eldercare facilities.

Open Letter: COVID-19 Study and Recommendations Task Force Established Pursuant to Massachusetts Bill H.4672

Pioneer hopes the members of this important task force will be appointed as soon as possible and that they will look into recommendations to address Covid-19 among the aged and in the state’s nursing homes. Read our Open Letter.

Combatting COVID-19: Life in the MGH Emergency Room

/
Join host Joe Selvaggi and Pioneer Senior Fellow Josh Archambault as they talk with Dr. David King about the experience of being in emergent care during a pandemic and lockdown. They explore the challenges of coping with a poorly understood virus during a lockdown, all while continuing to serve the sick.

Study Finds Pandemic Likely to Negatively Impact Biopharmaceutical Sector

Contrary to conventional wisdom that says the coronavirus pandemic will generally benefit biopharmaceutical companies, a new Pioneer Institute study finds many companies will emerge from the pandemic commercially weaker, dealing with delays in new product launches and with fewer resources to invest in research and development.

National Study Finds Most States Lack Healthcare Price Transparency Laws

At a time when the coronavirus pandemic has caused massive shifts in state policies on telehealth and scope of practice in healthcare, a new Pioneer Institute study underscores that most of the 50 states continue to suffer from weak laws regarding price transparency.  The study identified states that have laws that require carriers, providers or both to provide personalized cost information to consumers before obtaining healthcare services.  Fully 33 states placed in the lowest of the three broad analytic tiers on the strength of their state healthcare transparency laws. 

A Tipping Point for Telehealth – Bringing Healthcare into Your Home

/
This week on "Hubwonk," Joe Selvaggi and Josh Archambault talk with Dr. Roy Schoenberg, Chief Executive of Amwell, a global telehealth technology company headquartered in Boston, about the promise of telemedicine and how the COVID-19 pandemic has catalyzed broader adoption.