Medicaid: Through the eye of a needle


By Al Norman

State officials announced in late August that they had removed 205,000 people from Massachusetts’ Medicaid rolls, as part of a check to make sure that “everyone enrolled in MassHealth is eligible for it.”

Everyone on MassHealth has to be redetermined every year. To get on MassHealth, and to stay on MassHealth, is not an easy task. It is easier for a camel to go through the eye of a needle than for a poor elder to enter the rolls of Medicaid. That’s the gospel according to MassHealth.

The application document for an elder seeking nursing home or community-based services is roughly 33 pages long. An applicant must gather and submit proof of all income and assets, including Social Security and pensions. You have to show proof of rental income and expenses, like utility bills, heat and property taxes. You must compile health expenditures for the last three months if you want retroactive coverage. Elders have to prove what assets they have owned over the past five years, including bank account numbers and current balances. You have to submit the deeds for all property you own, copies of life insurance policies, any stocks or bonds, annuities, deposits for assisted living, car or mobile home registration, prepaid burial plans, trusts, etc. If you want MassHealth to pay for a nursing home or home care, you have to detail any “resource transfers” of money or property to others within the past five years.

It’s a major collection of written documents that most elders have to search for, and it can take weeks or longer to assemble. No wonder many frail seniors have to turn to others for help in completing this lengthy process.

MassHealth allows you to choose an “authorized representative” to handle all this paperwork. Some elders are lucky enough to get free professional help from health counselors in their community (like the excellent SHINE program), but some have to hire lawyers to help them navigate the process. I have heard of seniors having to spend several hundred dollars to get help finishing a MassHealth application.

Once you are enrolled in MassHealth, the challenges do not stop. I recently asked the agencies I work with to give me stories of elders struggling with the MassHealth eligibility process. Elder Services of Merrimack Valley sent me these stories:

“Richard L. is a 63-years-old who is on MassHealth. He recently submitted his Mass Health eligibility review, and was asked to submit additional information about his Blue Cross health insurance premiums. Richard sent his expenses in. This was around that time that members under the age of 65 were sent out the wrong applications and many of them got kicked off MassHealth. Although Richard was enrolled in a MassHealth home and community services waiver, he lost his MassHealth coverage. He was told the reason he lost his coverage was because he never sent in his eligibility review, even though our agency had copies in the file. After many attempts on our part, we were unable to get Richard back on MassHealth. He had to hire an attorney, and pay a legal fee, to get back on MassHealth. Richard spent most of the month of June in the hospital. His MassHealth termination came at a very inconvenient time and caused him much additional stress – when he should have been focusing on his health.”

In another case, Larry M. received a letter from MassHealth stating his renewal application was denied. His care manager had to personally assist him with the renewal forms, including collecting and submitting his information. Without MassHealth he cannot live at home. Another elder, Mary D., was denied MassHealth Standard four times, because the state was incorrectly calculating the breakdown of her monthly income. The state said her income was over the $973 income limit for MassHealth Standard. The elder was trying to get placed in a nursing home. Her care manager was able to assist her, but this was a lot of additional work for the family.

For many low-income consumers, the MassHealth application is a jigsaw puzzle with 1,000 pieces. For something as critical as health care, Massachusetts should ensure that consumers have access to benefits counseling that will result in a complete outcome. People should not have to hire lawyers to get on Medicaid.

It is reasonable to eliminate people who do not meet the eligibility rules for MassHealth. But at the same time, we should be just as concerned about eligible people who never get into the program because the admissions process is too complicated. People who don’t have MassHealth show up in emergency rooms for problems that could have been avoided. Providing independent benefits counselors at the city and town level would be a good place to reform MassHealth and a smart investment for the commonwealth.

Al Norman is the executive director of Mass Home Care. He can be reached at or 978-502-3794. Archives of articles from previous issues can be read at