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

This is a state audit of how MassHealth’s Tewksbury 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 Tewksbury enrollment center for the period January 1, 2017 through December 31, 2018.”

The State Auditor reviewed the center as part of its regular oversight of Medicaid, focusing on whether income checks were being done correctly.

“This audit was conducted as part of OSA’s ongoing independent statutory oversight of the state’s Medicaid program.”

MassHealth is a very large public program, serving many residents and using a major share of the state budget, so eligibility checks matter for public trust and spending.

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

If you are a Massachusetts resident who uses or may need MassHealth, this audit suggests the Tewksbury office’s income-check process did not show significant reportable problems during the audit period.

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

The auditors answered yes: the Tewksbury enrollment center verified walk-in applicants’ income and revoked benefits when people were found ineligible based on the rules reviewed.

“Did the Tewksbury 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 report does not call for corrective action because the audit did not find significant noncompliance that had to be reported.

“Our audit revealed no significant instances of noncompliance that must be reported under generally accepted government auditing standards.”

The finding is significant because auditors sampled applicant records, checked income documentation, compared data with state wage records, and still found no major reportable compliance issues.

“We requested and received wage information for the 176 applicants in our test sample from the Massachusetts Department of Revenue (DOR).”

In plain terms, MassHealth checks whether a household’s income is low enough for the coverage type and family size, using the federal poverty level as a benchmark.

“The gross earned and unearned income of all family group members cannot exceed a designated percentage of the federal poverty level (FPL).”