‘Hands Off Our Healthcare’ aims to address nationwide coverage loss

In the past six months, Medicaid enrollment has dropped by 5.3 million people nationwide. In Massachusetts, enrollment in MassHealth, the state’s Medicaid program, has dropped by nearly 94,000 people.

Those decreases, the focus of a new campaign by the NAACP, come as states reinstitute the annual process of redetermination, which verifies if a recipient is qualified to receive Medicaid, based on factors such as income. During the COVID-19 pandemic, states were not allowed to disenroll anyone involuntarily from Medicaid, which is the largest source of health care coverage in the U.S. That prohibition ended on April 1.

Under the redetermination process, what is officially being called “unwinding,” about 71% of people who lost coverage nationwide lost it due to “red tape” or procedural reasons, meaning their coverage was cut for reasons based on process — like not receiving or responding to mail with reenrollment information — rather than ineligibility for coverage.

“This is history’s largest, deepest and steepest coverage loss for Americans, and we’re not talking about it enough,” said Idris Robinson, director of health and well-being at the national NAACP, who led the campaign, called “Hands Off Our Health Care.”

As part of the campaign, run in coordination with seven other civil rights organizations, each state was graded with a passing or failing score, based on criteria around the rate of procedural disenrollments and how they are approaching Medicaid renewal processes.

Out of all 50 states and the District of Columbia, only one — Hawaii — received a passing score. Twenty-five others received failing grades. The rest — including Massachusetts — were marked as incomplete.

In September, the U.S. Centers for Medicare and Medicaid Services required 30 states to pause disenrollment due to concerns that systems issues were improperly disenrolling Medicaid recipients. At the time, CMS said the issue in Massachusetts was related to MassHealth recipients in the same household who had different eligibility statuses. CMS said the issue had affected “less than 10,000” individuals in Massachusetts. According to reporting from the Boston Globe, state officials have clarified that this “glitch” caused 4,800 people to mistakenly be dropped from Medicaid.

“Our first ask is that procedural disenrollments are stopped, and some states stopped. Even though it wasn’t voluntary, they did stop,” Robinson said. “The second part is we want to make sure states don’t just leave it at a stop when considering [whether] these residents, these citizens are eligible for Medicaid, make sure that there’s some system in place doesn’t allow them to have a gap in coverage or lose coverage if they’re still eligible.”

For the states that received a score, the rate of procedural disenrollments was a prominent metric.

On the scorecards, the NAACP and its partner groups set a goal of 5% or below for that rate, which compared the share of people disenrolled for reasons not related to eligibility to those disenrolled because they actually no longer qualified.

“It’s our belief that no one should lose coverage for some systems reasons,” Robinson said. “We understand, with just general computer errors, system glitch, or anything related to that, that 5% is just that safe number. It can be rectified.”

Only Wyoming had less than 5% procedural disenrollments, though it still received a failing grade because it has not adopted Medicaid expansion, another metric the NAACP considered. Others, including Illinois, Maine and Oregon, came close, with 16%, 20% and 7% rates, respectively. Most states, however, had a procedural disenrollment rate of over 50%.

Even as Medicaid disenrollment in Massachusetts is paused under federal guidance, community health centers, which are equipped to help MassHealth recipients renew their coverage, are continuing to do their work, said John Nichols, director of patient financial services at Whittier Street Health Center in Roxbury.

Nichols said the state’s redetermination process, which begins when recipients receive a blue envelope telling them they need to renew their coverage, seems to be successful. He’s seen people coming in with their letters and requesting help in the process.

“I think it’s going surprisingly well, considering the volume,” Nichols said.

People across the state continue to receive notification, and he encouraged them to respond quickly and seek help if they need it.

For the NAACP, the campaign and scorecards offer an opportunity to highlight other topics around Medicaid, like expanding the coverage it offers, but the disenrollment process means some of those conversations have to wait.

“Medicaid is a very politicized conversation piece. You don’t want to scare people away from that,” Robinson said. “What we’re trying to do is, using our Medicaid scorecard, speak to again a larger conversation that we will have — but we can’t even get to that conversation if those that are still eligible for Medicaid as it is currently in each state are still being kicked off.”