Audit of the Office of Medicaid (MassHealth) - A Review of MassHealth Member Eligibility at the Chelsea Enrollment Center

This is a State Auditor review of how MassHealth’s Chelsea enrollment center checked income eligibility for people applying in person.

“In this audit, we reviewed the asset/income-related eligibility verification activities that MassHealth conducted at its Chelsea enrollment center for the period January 1, 2017 through December 31, 2018.”

The Auditor’s office regularly reviews MassHealth to help catch fraud, waste, abuse, and eligibility problems.

“The Office of the State Auditor (OSA) receives an annual appropriation for the operation of a Medicaid Audit Unit to help prevent and identify fraud, waste, and abuse in the Commonwealth’s Medicaid program.”

MassHealth is a huge public program, covering about 1.9 million people and spending billions of dollars, including state taxpayer money.

“MassHealth provides access to healthcare for approximately 1.9 million low- and moderate-income children, families, seniors, and people with disabilities annually.”

If you are a Massachusetts resident who uses or may apply for MassHealth, this audit suggests the Chelsea office was generally checking walk-in applicants’ income as required.

“Did the Chelsea enrollment center verify the income of MassHealth walk-in applicants and revoke benefits from MassHealth members who were found not to be eligible according to Section 502.003 of Title 130 of the Code of Massachusetts Regulations?”

The Auditor concluded that the Chelsea enrollment center did verify income and revoke benefits when applicants were found ineligible based on income.

“Below is our audit objective, indicating the question we intended our audit to answer and the conclusion we reached regarding the objective.”

The report does not list corrective actions or recommendations, because the audit did not find significant reportable noncompliance.

“My audit staff discussed the results of this audit with MassHealth management.”

This matters because Medicaid is one of the largest parts of the Massachusetts budget, so eligibility checks affect both public spending and access to healthcare.

“Medicaid expenditures represent approximately 39% of the Commonwealth’s total annual budget.”

In plain terms, “income eligibility” means MassHealth checks whether a household’s earned and unearned income is low enough for the type of coverage requested.

“Applicants must meet certain income requirements to qualify for MassHealth coverage.”