The Blue Cross Blue Shield Foundation has issued its annual report on MassHealth, MassHealth: The Basic Facts and Trends, containing a wealth of information about the role our form of Medicaid takes in keeping our state healthy, and what it costs to do so. It also explains the complicated eligibility rules for various forms of the program.
Who’s Covered, At What Cost
Here are some of the nuggets of information found in the report:
- One in four Massachusetts residents. 2.2 million, are covered by MassHealth.
- MassHealth enrollment grew by 30% during the Covid-19 pandemic.
- It has since dropped by 17%.
- MassHealth spending grew from $14.3 billion in 2019 to $20.6 billion in 2024, largely due to increased enrollment.
- Enrollees include:
- 19,532 seniors in nursing facilities
- 210,553 seniors in the community
- 257,798 adults with disabilities
- 40,581 children with disabilities
- They include large portions of certain populations, constituting:
- 46% of children
- 19% of seniors
- 69% of nursing facility residents
- 60% of people with disabilities requiring assistance with self care
- 25% of Medicare beneficiaries
- Many people who are working are covered by MassHealth, including
- 86% of sales workers
- 82% of food service workers
- 56% of nursing assistants and home health aides
- Seniors account for 10% of enrollees and 24% of expenditures.
The Future?
The report predicts the following effects of the Medicaid cuts in the Big Beautiful Bill:
- 300,000 Massachusetts residents will lose their MassHealth or Connector coverage.
- Federal contributions to MassHealth will be reduced by $3.5 billion a year when the law is fully implemented.
- 110,000 – 180,000 additional beneficiaries will lose their coverage due to new work and six-month redetermination requirements.
- Hospital will lose 18% of their Medicaid funding.
How About MassHealth for All?
There has been a campaign to make Medicare universal so that all Americans would have the same coverage as most seniors aged 65 or above. This has a lot of appeal because it would provide universal coverage at a lower cost than what those with insurance pay for private health insurance. By having a single payer, it would also simplify the system for all concerned, including health care providers.
But extending Medicare to all Americans would require federal action which seems unlikely anytime soon.
As a result, I’ve long wondered why we couldn’t extend MassHealth coverage to all residents of the state. Doing so would ease some of the administrative burdens of vetting everyone for eligibility.There would no doubt be complications since we would only receive federal reimbursement for those who qualify under the federal rules.
This could be resolved by negotiating a flat payment from the federal government as Rep. Jake Auchincloss recommended in a recent op-ed in The Boston Globe. It’s totally clear to me how Rep. Auchincloss’s proposal is different from the block grants that have long been pushed by Republicans and opposed by Democrats. Perhaps its that the block grant proposals were always accompanied with a plan to limit their size over time, reducing the federal contribution and increasing the cost to the states.
No doubt, those with generous insurance coverage through their employers would opt out of universal coverage. Those employers who chose to stop providing coverage to their employees could be required to pay into MassHealth to cover its increased costs.
I’d be curious to hear comments from readers about this concept, pro or con.