Blue envelopes signal start of big health insurance project

Jun 29, 2023

Credit: Mass.gov

by: Colin A. Young, SHNS

Posted: Mar 9, 2023 / 04:48 PM EST

Updated: Mar 9, 2023 / 04:48 PM EST

BOSTON (State House News Service) – If you have insurance through MassHealth, be on the lookout in the coming months for a blue envelope in your mail.

Hundreds of thousands people are expected to be booted off the state-run health insurance program over the next year as federal continuous coverage requirements for Medicaid in place since March 2020 expire and the state goes through the required redetermination process for the first time since the pandemic began. The Healey administration expects that MassHealth membership will fall from its current level of more than 2.3 million people to about 1.9 million people over the next year, freeing up $1.9 billion in fiscal year 2024 state spending.

Mike Levine, MassHealth assistant secretary, said Thursday that an estimated 50 percent of MassHealth members can be automatically renewed. Those members will get a letter in the mail telling them that their eligibility has been renewed and that no action is needed of them.

"For the subset of members where we cannot automatically process their renewal, we are going to be sending a blue envelope that hopefully is hard to miss," Levine said. "That will include a form with all the information we need from them that they need to return to us. They can send it back via the mail, they can call us, they can go online, there are many, many channels that members have to get MassHealth the information that we need. But we want to make it as clear and bold and visible for members as possible that there's this blue envelope that indicates that you need to take action."

But because it's been three years since failure to respond to a letter from MassHealth has put members at risk of losing their coverage, Levine said MassHealth has already begun reaching out to members "to make sure people understand that there will be repercussions for their coverage if they don't respond to information requested in that blue envelope."

The agency is also preparing to handle the higher number of interactions with members.

"We are doubling the number of contact customer service representatives that we have at our call centers, we are staffing up our eligibility centers to make sure that members can get the support with their applications that they need, we are hiring additional staff to process paper applications since we expect a higher volume, we are doing everything within our power to make sure that we can meet the higher volume that we expect over this period," he said. Levine added, "Small things that tend to trip members up in the application process, we’re trying to streamline as much as possible and, again, get more folks automatically renewed where appropriate."

Levine said Thursday that it is important for people to know that getting a blue envelope in the mail does not mean you have lost your coverage.

"You have 45 days from when you get a piece of mail from us to respond. If we need more information, then you get another 90 days to provide that follow-up. And then if we don't have what we need or it seems like the right decision is that you’re no longer eligible, then you have another 14 days prior to actually losing coverage," he said. "And then after that, there's actually something called a 90-day reconsideration period where if we didn't hear from you, but then you found our envelope later and you call and say, ‘no, no, I’m still eligible,’ you actually have 90 days where then we’ll reinstate you back to when you lost coverage."

That 14-day window between when MassHealth determines that someone is no longer eligible and when they actually lose coverage is critical, he said, because that's when the Massachusetts Health Connector can step in to help the person find other subsidized insurance coverage.

"We know that the Connector is going to be a natural landing place for a lot of folks that may be losing MassHealth eligibility over the course of the next 12 months," Health Connector Executive Director Audrey Morse Gasteier said. She added, "We’ve been really getting ready for this event for almost the whole three-year period, thinking about all the ways that we can be most responsive when this time period came upon us."

Gasteier told the Health Connector board Thursday morning that the Connector's "utmost priority continues to be our careful preparation for the MassHealth redetermination process" and that the health insurance exchange is "squarely focused on ensuring that we successfully and smoothly enroll as many as possible of the hundreds of thousands of residents who will newly need health coverage over the course of the next year."

The Health Connector is opening a special enrollment period from April through November for those who lose MassHealth coverage, and there will be an information campaign that will include sending mail, emails and text messages, and using social media, TV and radio, robocalls and old-fashioned door knocking to let people know they may lose their MassHealth insurance and can enroll in Health Connector coverage.

MassHealth and the Health Connector are also relying on an "integrated eligibility system" that Gasteier said "means that the second somebody loses their MassHealth eligibility, they become eligible potentially for Health Connector coverage." People who lose MassHealth coverage will find out immediately that they are eligible for a Connector program, she said.

"They don't have to come and apply to a new organization. This system all kind of handles that seamlessly," she said. "So that allows us to directly communicate instantaneously to the people that are going to be losing MassHealth coverage, if that's what's determined through their redetermination process."

The Health Connector will also highlight the fact that it is "the only place where people in the commonwealth can get help paying for health coverage" and that there are more subsidies available than ever before.

"We know it’ll be a transition for people to go from not paying any premiums for their health coverage to potentially have to paying some premium. So we don't want people to assume they can't afford it. We want people to come check out their options," she said.

And the Connector will also remind people that they have to meet the state's individual mandate that most adults have "minimum creditable coverage" all year.

"We don't like to hammer that message or use it as kind of a stick. We know people in the commonwealth value health insurance, we have a culture of coverage here but we do want to let people know that coverage gaps beyond a certain number of months can result in a tax penalty," Gasteier said. "So it's not the kind of gap you want to have and keep putting off and putting off and putting off."

At a meeting Thursday morning, the Health Connector board approved a $3.6 million contract with Archipelago Strategies Group, the Connector's longtime outreach and communications vendor, for an outreach and visibility campaign aimed at people who could lose MassHealth coverage.

The Connector is talking to Telemundo and Fox about running ads during the Women's World Cup in July through August, planning an ethnic media campaign that communications director Jason Lefferts said is "at least as ambitious as our open enrollment efforts," and is arranging to have ads on the MBTA, regional transit authorities and billboards.

There will also be a series of 18 enrollment events at locations around the state, starting with a June event at Fenway Park, Connector officials said.

"It will be our most ambitious public messaging effort since we launched the new [health insurance exchange] in the fall of 2014," Gasteier said.

The Connector in the fall of 2014 rolled out a revamped insurance purchasing website after the first attempt to implement the Affordable Care Act failed in disastrous fashion and complicated the enrollment process for hundreds of thousands of residents.

The fallout from the failure was a major storyline in 2014 as Gov. Deval Patrick's administration severed ties with the contractor that missed deadlines and delivered a faulty product, hired new web developers, and raced to build the new site. Officials at the Health Connector tried to prevent residents from losing insurance by extending existing plans and enrolling hundreds of thousands of subscribers into temporary Medicaid plans.

Then-Executive Director Jean Yang broke down in tears at a board meeting as she spoke of the demoralizing effect the fiasco and public attention on it had on her staff.

All told, what was to be a $174 million project turned into a $254 million exercise, with the state's share climbing from $16 million to $42 million, not counting the costs of keeping consumers enrolled in coverage while the site was rebuilt. Those costs contributed to a sizeable budget gap heading into 2015.

"What happened at the Connector was a mess. We know it was a mess, and that's why the action was taken under the prior administration to look at this issue," Attorney General Maura Healey said in May 2015 while her office had an investigation of the Health Connector underway.

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