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Resources for Massachusetts Employers on MassHealth Redeterminations and Supporting Employees into New Coverage

Federal COVID-related Medicaid coverage rules ended in April 2023, which means hundreds of thousands of Massachusetts residents are expected to need new health insurance as their MassHealth coverage ends. MassHealth’s process of redetermining the eligibility of 2.3 million people who are currently MassHealth members will take approximately 12 months, through April 2024.

Many of those individuals who lose MassHealth coverage during this time may be employees who need coverage through their employer’s plan.

  • In April 2023, MassHealth began redetermining the status of program members. With the end of the federal COVID-related Medicaid protections, many Massachusetts individuals and families will no longer qualify for that coverage and must find new health insurance.

  • Massachusetts requires everyone to have health insurance or face a tax penalty if someone doesn’t have coverage.

  • Employers are asked to help Massachusetts maintain its near-universal health insurance rate by connecting employees losing MassHealth coverage to new health coverage.

  • For employees who lose MassHealth coverage but who are eligible for their employer’s health plan, companies should ensure employees have the opportunity to enroll in the employer’s health plan if they are eligible.

  • Please note that loss of MassHealth (Medicaid) coverage is a HIPAA special enrollment event permitting eligible employees to request enrollment in their company’s health plan within 60 days after losing coverage. However, employers are strongly encouraged to extend this special enrollment period beyond the minimum 60 days required by statute. This action is in line with extended special enrollment periods through the Exchanges during the Medicaid redetermination process, and some employees are already eligible for a longer special enrollment period under emergency relief issued by the federal government. (See FAQs for more information.)

  • Employers who do not offer health benefits*, who have employees who aren’t eligible for the employer’s health plan (such as part-timers and contractors), or offer coverage that is considered unaffordable, should direct their employees to the Massachusetts Health Connector for new coverage.

    The Health Connector is Massachusetts’s official health insurance marketplace. Its plans meet state standards and provide access to vital services; it’s also the only place for residents to access subsidies to help pay for health insurance. Employees who already have access to coverage considered affordable under Affordable Care Act standards are not able to access that help paying for coverage through the Health Connector.

*Small businesses with 50 employees or fewer who do not currently offer health benefits can access  Massachusetts Health Connector for Business if they’d like to start to offer health coverage to employees.

Webinar Recording: MassHealth Renewals and Available Resources for Massachusetts Employers

About this Video: On March 13, 2024 MassHealth and the Massachusetts Health Connector held an informational briefing for Massachusetts employers who may have employees who may currently be enrolled in MassHealth coverage and may be impacted by the ongoing redetermination process. The webinar was aimed at helping employers know what is happening and what steps they may need to take help ensure state residents continue to have access to health coverage.

Transcript: Coming Soon

Resources

Resources

Find helpful resources and frequently asked questions below for Massachusetts employers.

Letter to Massachusetts employers

Employee Flyer

Newsletter copy for employer associations

Newsletter graphics

Newsletter copy for employer associations

Newsletter graphics

Template Messages for Employers to Share With Employees

Use the following templates to communicate to employees who may no longer be eligible for, or may have already lost, Medicaid coverage. (File format: Word Document, DOCX)

Frequently Asked Questions

Since March 2020, federal COVID-related protections have allowed people to stay enrolled in MassHealth. Those protections ended April 1, 2023, which means hundreds of thousands of Massachusetts residents are expected to lose their MassHealth coverage in the coming months and will need new health insurance options. Many of those individuals may be employees who need coverage through their employer’s plan or a different source.

View or download FAQs as a PDF →

MassHealth is the Commonwealth’s Medicaid program. During the COVID pandemic, people in Medicaid programs like MassHealth who normally would have lost coverage could keep that coverage. However, MassHealth is redetermining the status of all 2.3 million people who are MassHealth members over a 12-month timeframe that started in April 2023. Most of those people will stay in MassHealth, but many people will no longer qualify for MassHealth and will need new coverage.

Related resource:

Massachusetts requires everyone to have health insurance or face a tax penalty if someone doesn’t have coverage. Therefore, if someone in your organization is losing MassHealth coverage, now is the time to help them find new coverage to ensure they do not have a gap in their health insurance and can take advantage of the important health care benefits and services accessed by having coverage.

Related resource:

Yes, and this may be the best and simplest way for your employee or dependent to maintain coverage. MassHealth is redetermining eligibility and ending coverage for some members over the course of twelve months that started in April 2023. If your employee or dependent is determined no longer eligible for MassHealth coverage, the employee will receive a notification from MassHealth indicating when their MassHealth coverage is ending. You will have a window of time to add your employee or dependent to coverage because the loss of MassHealth coverage is a HIPAA special enrollment event. That typically allows eligible employees or dependents to request enrollment in your company’s health plan within 60 days following the loss of MassHealth coverage.

However, employers are strongly encouraged to extend this special enrollment period beyond the minimum 60 days required by statute. This action is in line with extended special enrollment periods through the Exchanges during the Medicaid redetermination process, and some employees are already eligible for a longer special enrollment period under emergency relief issued by the federal government.

Employers should refer to the guidance in the related resource below, issued by the Departments of Labor (DOL), Health and Human Services (HHS), and the Treasury to ensure employees have access to their full and possibly extended special enrollment rights.

Related resource:

No. You can follow your usual process when you add an employee or dependent to your company’s plan. Contact your broker or whoever manages your company’s health insurance policy to add an employee.

Your employees could choose to shop through the Health Connector instead, but they won’t qualify for state or federal premium savings if the cost of your plan is considered affordable under federal standards. However, if the health plan you offer is considered unaffordable, employees could potentially qualify for help paying for Health Connector coverage through MAhealthconnector.org.

It is very likely that your employer-sponsored coverage meets the standards for affordability. In 2024, an employer’s plan is considered affordable if the employee’s share of the monthly premium in the lowest-cost plan offered is less than 8.39 percent of the employee’s household income. If you are unsure if your employer-sponsored coverage is considered affordable, the Health Connector does have a worksheet that can help you find out.

In 2023, changes were made so that an employee’s contribution toward employer-sponsored family coverage is taken into account to determine affordability. This means that if the employer coverage is affordable for the employee but not for family members, the employee might still stay in their employer coverage, while any dependents may be determined eligible for financial help and enroll in a plan through the Health Connector.

In our current competitive workforce environment, now is a great time to offer additional benefits for your employees, including health insurance. If your company has 50 or fewer employees, you can start at the Massachusetts Health Connector for Business, a state health insurance Marketplace that caters to small businesses with lower-cost plans and options to save money while providing plan choices to employees. You can also find a certified broker who can help you complete an application and pick a plan. Find out more about Health Connector for Business at MAhealthconnector.org/business.

If you have more than 50 employees, a broker can help you establish a plan to meet your needs and the needs of your employees. You can make sure you’re finding a state-licensed broker by going to the Division of Insurance website.

Related resources:

If you have an employee who needs health insurance, encourage the employee to consider coverage through the Massachusetts Health Connector. The Health Connector is the state’s health insurance Marketplace, offering individuals and families a range of quality, commercial plans that meet state standards for covered benefits and services. The Health Connector is also the only place people can get help paying for their health insurance premiums. People who no longer qualify for MassHealth will get information from the Health Connector. However, they can visit the Health Connector at any time at MAhealthconnector.org, or call 1-877-MA-ENROLL (TTY: 711) to get help in any language.

Unfortunately, many websites that come up in search results are from companies that do not offer plans that meet state standards. These products often don’t cover basic services, including elective tests, procedures, or even emergency care. This means a policyholder is paying monthly premiums but may be stuck with medical bills for care and a tax penalty for not meeting the standards for the Massachusetts individual mandate.

The best way to make sure employees are choosing a qualifying plan is through the Massachusetts Health Connector. All health plans meet state standards and provide access to vital services. Plus, the Health Connector is the only place for residents to access subsidies to help pay for health insurance. Visit MAhealthconnector.org to learn more.

Related resource:

You can fill out the form below, or you can check back here as we update information, along with a calendar of public webinars and other activities where you can learn more about health insurance for your employees.

News and Updates

July
2023

Important Notice: Special Enrollment Period for Individuals Losing MassHealth Coverage During Medicaid Unwinding

We want to bring your attention to an update from the Centers for Medicare and Medicaid Services. The U.S. Departments of Treasury, Labor, and Health and Human Services have issued a joint letter urging employers and plan sponsors to extend the special enrollment period for individuals losing Medicaid (MassHealth) coverage. This period goes beyond the minimum requirement of 60 days and is part of the Medicaid Continuous Enrollment Unwinding process.

It is crucial for employers and plan sponsors to understand the complexities of this transition and the importance of ensuring continuous and life-saving coverage for their employees and their families. To learn more about the steps that the federal Marketplace is taking and access the Departments’ letter, please visit: https://www.cms.gov/files/document/esi-letter-final.pdf

Have questions?

If you are a Massachusetts employer and have questions about MassHealth redeterminations, please use the contact form below to reach out to us.

  • Please fill out the information below:
  • Write your question in the box provided below. Please DO NOT include any additional personal information such as Social Security numbers, date of birth, addresses, or bank account numbers.