Raise a glass and sing Auld Lang Syne to remember two historic MassHealth programs that are ending today.
New Years Day 2014 brings profound changes to MassHealth, our Medicaid and CHIP program. These changes will transform the program as much as the changes that accompanied the creation of MassHealth, in 1996.
The national transformation will be even more dramatic, as starting on 1/1/14, the ACA allows all states to set Medicaid eligibility based solely on income. And, as usual, it all starts with Massachusetts.
MassHealth is built on a federal waiver originally granted to the Commonwealth in 1996. It allowed the state to begin to break out Medicaid from its traditional role as the health program that goes along with welfare. Cash welfare benefits generally go to 4 groups, and these were the ones eligible for Medicaid before 1996: the elderly, children, parents, and those with disabilities. The 1996 MassHealth reform allowed more parents and children to become eligible. Even more revolutionary was eligibility for adults who were not parents, under a new program called MassHealth Basic.
MassHealth Basic was originally set up to cover what Judy Meredith affectionately called “bums in the street,” adults with below-poverty incomes who had been out of work for the past year. Because the program was a federal experiment, the state was given the ability to reduce benefits, cap enrollment, and even eliminate the program to control expenses.
So in April, 2003, eligibility for the program was reduced as then House Speaker Tom Finneran demanded deep budget cuts in health care programs. Over 36,000 people lost coverage. HCFA launched a furious campaign to restore the program, and in October, 2003, the program was brought back to life. The replacement coverage program (with further reduced benefits) was called MassHealth Essential, as lawmakers tried to come up with an even stingier adjective than “basic.”
But budget concerns again led to the Romney administration to cap enrollment in 2005. Eventually 12,000 people languished on the waiting list, eligible for coverage, but with no slots to allow them to enroll. We insisted that the broad health reforms then being negotiated include ending the waiting lists for MassHealth Essential. The final version of Chapter 58 (“RomneyCare”) included the provision ending the enrollment cap (section 107).
Starting today, the ACA lets all states choose to offer Medicaid based solely on income. That provision builds on a model pioneered in Massachusetts.
Here, MassHealth Basic and MassHealth Essential are ending today, to be replaced by a new program, called MassHealth CarePlus. Many people formerly in Commonwealth Care will also get their coverage through CarePlus. Here’s a MassHealth guide to CarePlus, and a general FAQ on changes to the MassHealth program for 2014 under health reform.
(Also ending today is the Medical Security Program, which dates back to the 1988 Dukakis universal coverage law and provides coverage to people receiving unemployment insurance, and the insurance partnership program, a Weld administration-era program for workers in small companies that never took off the way Charlie Baker envisioned.)
We’re pleased that CarePlus will simplify and unify various flavors of MassHealth into a more rational program design, so we’re not sad to see Basic and Essential go away. Their tortured history represents the long struggle for expanding health care to those with no other source of coverage.
As one of the models for the ACA’s Medicaid expansion, MassHealth Basic will lead to coverage for as many as 10 million people nationally in the states that choosing the expansion. Another 3.6 million eligibles live in states that are not expanding coverage now.