This analysis of enrollment data in the HUSKY program for 2010 finds that more than one in six children experienced a gap or loss of coverage during the year. Babies who turned one and adolescents who turned 18 in 2010 were about twice as likely as other children to have had gaps or lost coverage.
For these latter age groups, the loss of coverage is likely due to a review of eligibility that is triggered by these children's age changes. Just prior to the first birthday of babies enrolled in HUSKY A, the Department of Social Services sends the family a notice of discontinuance for the baby that states “YOU ARE NOT THE RIGHT AGE TO BE ELIGIBLE FOR THIS PROGRAM.” Results of a study using enrollment data from 2008-09 showed that over 40 percent of babies in the newborn coverage group were not enrolled in the month following their first birthdays. Children who qualify for coverage in HUSKY A are eligible until the age of 19. Prior to national welfare reform in 1996, federal regulations tied Medicaid eligibility to eligibility for cash assistance and prohibited assistance (cash or medical) for 18 year olds who were not enrolled in school. After welfare reform, the link between Medicaid and cash assistance was severed; however, it appears that some of the administrative procedures, computer programming, and approaches to redetermination still apply when eligibility for 18 year olds is reviewed. Analyses of 2006-07 enrollment data showed that 16 percent of adolescents were not enrolled in the month following their 18th birthdays.
Gaps in coverage affect access to care. Many children who lose coverage subsequently reenroll. A recent review of the literature by the Massachusetts Medicaid Policy Institute (MMPI) points out that gaps are costly to the state. Health care costs after a gap in coverage may be up to two times higher than before the gap, depending on how many months the child was without coverage. Results of this study show that redetermination of eligibility at ages one and 18 jeopardizes continuous HUSKY coverage.