Congress may cut funding to MassHealth. For some in New Bedford, it’s a major source of support

About 150,000 people in Massachusetts could lose MassHealth coverage if Congress approves cuts to Medicaid, according to the state government. MassHealth cuts could hit the South Coast especially hard. 

The U.S. House of Representatives passed its “Big, Beautiful Bill” in May, a budget bill that includes massive cuts to Medicaid — a government program that provides low-income people with health insurance. The Senate version of the bill, which faces a vote this week, also features hundreds of billions of dollars in Medicaid cuts.

A study in the Annals of Internal Medicine found that the House’s proposed cuts could deprive 7.6 million people of health insurance and lead to more than 16,600 deaths. 

MassHealth, Massachusetts’s name for Medicaid, is the biggest line item in the state budget, and federal funding covers about half of its cost. As the state prepares a budget amid uncertainty about federal funding, people on the South Coast imagine a future with less Medicaid funding.

The House bill would cut $1.75 billion a year from Massachusetts’ federal health funding, according to Gov. Maura Healey’s administration. About 150,000 people would lose MassHealth coverage, the state estimates. Currently, MassHealth insures more than 2 million people in a state of 7 million. Up to another 100,000 people could lose coverage that they buy through Massachusetts Health Connector, the state-run health insurance marketplace. 

In the Southcoast Health system that serves New Bedford, most people are on public pay programs like MassHealth. This puts the region at heightened risk.

Nonprofit and community-based health providers and systems that serve a higher percentage of patients on Medicaid are likely to be hit the hardest, according to state officials.

Kaitlyn Johnson, manager of public communications and media relations for Southcoast Health, said it is focused on collaborating with community partners, state and local leaders to care for the most vulnerable populations in the area amid the uncertainty. 

“As a not-for-profit community health system, we are monitoring this situation closely,” Johnson wrote. “We are always evaluating how we can provide the most advanced care and service to our patients and support our dedicated providers and staff.”

Barrier or opportunity?

The U.S. House bill includes a work requirement for low-income adults aged 19 to 64 who are enrolled in Medicaid through the Affordable Care Act’s Medicaid expansion. It would end coverage for people on Medicaid unless they can show they’re doing paid work or another qualified activity for 80 hours per month. The bill would apply the same requirement to every state.

Other states have tried work requirements like this, none of which lasted long or were considered successful. The House bill would deny coverage if applicants could not demonstrate that they meet the work requirement, and would disenroll them if they fail to meet the standard later. 

Many argue these requirements don’t actually push people towards work, or help them become employed. In Arkansas, a quarter of the people subject to its work requirement lost their Medicaid coverage in the first seven months, and research showed the requirements didn’t affect employment.

But some still support work requirements, and argue this research is misleading. Josh Archambault, the Pioneer Institute’s senior fellow on health care policy, said these numbers don’t account for the people who simply found jobs, got private health insurance, and never informed the state. 

He also said that because no state ran a work requirement for very long, or did so despite impediments from the federal government — Georgia sued the Biden administration after contentious negotiations over implementing a work requirement — they’ve not been properly tested.

The state’s MassHealth budget has almost quadrupled over the last 20 years, Archambault said. He said most of the growth to MassHealth has come from non-disabled adults. Archambault said that forcing the state to prioritize spending only on essential services would mean better health outcomes overall.

“If what the House passed becomes law … there will need to be conversations in the state about how you improve people’s health and what you prioritize,” Archambault said. “I think it’s an open question on whether orienting [non-disabled people on the program] towards work leads to healthier outcomes.” 

Still, studies show that more than 90% of eligible adults on Medicaid nationally are already either working or exempt from the requirement.  The Congressional Budget Office estimated in 2023 that national work requirements would lower federal spending with fewer people on the program, and in 2022, the CBO reported that states’ limited experience with work requirements in Medicaid indicates “they appear to have little effect on employment.” For many, excessive paperwork is a barrier. 

Daniel Mumbauer, president and CEO of High Point Treatment Center for substance use and mental health disorders, shares these concerns.

“If you look at folks with addiction disorders and mental health disorders, they struggle to do paperwork … to be organized,” Mumbauer said. “I’m concerned about a lot of people who actually will be eligible for MassHealth [who] will lose MassHealth because they don’t get the darn paperwork done, and it just makes it much worse than it needs to be.”

Mumbauer is looking into ways to support his patients, and help them get back on MassHealth if they do lose it. But he also worries about how much support mental health issues will get. 

“My concern is more about the folks that we treat and are trying to help stabilize with their addiction and mental health,” Mumbauer said — “about them losing other support that’s allowing them to do well in treatment.”

New Bedford’s community organizations prepare and react

Danielle Brown is the program director for Steppingstone, a local organization that offers counseling and addiction, housing and homeless services. She said that MassHealth has issues of waste to address. But none of that, she said, overshadows the fact that people rely on it for their livelihood. 

“We need to look at what’s behind the dollar, and what we’re cutting behind the dollar is what’s important,” Brown said. “We need to learn to manage how we’re using these funds, but cutting the funds? Absolutely not. Too many lives depend on them.”

Brown herself relied on MassHealth while she was raising her three children. She’s on private health insurance now, but this isn’t without challenges.

Brown had to take a leave of absence from work a few years ago, and paying for her health insurance was a big hit. After a heart attack and a stroke, she found herself crying in a pharmacy because she couldn’t afford the medication she needed to live. 

The pharmacist helped her figure out a way to pay for them with the pharmaceutical company, but Brown said this isn’t always an option.

“I think of this all the time, the individual who does not have a job like me — what is going to happen to them when they can’t get their medications?” Brown said. “So that’s where those dollars come in.”

Multiple people Brown has worked with at Steppingstone credited MassHealth with making it possible for them to get sober, and eventually to get housing.

Mumbauer, at High Point, doesn’t want to panic about the threats on MassHealth. He’s concerned that fewer people may be eligible for the program, but he wants to find reasonable solutions.

The majority of High Point’s funding comes from Medicaid, and public health services are its next biggest source. So, Mumbauer wants to make sure that if he has to rely more heavily on state funding for addiction treatment to cover uninsured patients, High Point has a reserve of money to cover costs as well. 

“Am I uncomfortable? Yes, absolutely,” Mumbauer said. “We have a great delegation at the federal level that obviously are totally supportive of trying to make sure a lot of these changes don’t happen. We’re very fortunate to be here in Massachusetts, because we definitely have a great perspective of caring for others in our state.”

While federal Medicaid cuts would mean a huge funding loss for the state, private health insurers are planning to increase rates by an average of 13.4% for small businesses and individuals.

Carl Alves, chief executive director of Positive Action Against Chemical Addiction, worries about the ripple effects that cuts to MassHealth could have. 

Alves said that if you take MassHealth out of the equation, much less money would go into the state’s medical care system overall. There would be less preventative treatment, and more visits to an already backed-up emergency room, because people have nowhere else to go. “It just weakens our ability to take care of everybody,” Alves said.

“We all benefit when we have a good flow of health care services, and when people can utilize the appropriate level of care, and that level of care is being utilized effectively,” Alves said. “That’s when things work best for everyone, not just folks in need, but folks that might have excellent insurance.”

People Acting in Community Endeavors works in Greater New Bedford to provide services and programs to people in need. This includes a MassHealth enrollment program. 

PACE works in collaboration with local schools to refer children to the program. Pam Kuechler, executive director, estimates that at least 80% of people PACE works with are on MassHealth. 

Many of PACE’s programs are at risk of funding cuts, and Kuechler said they’re all connected. She, like Alves, said that without MassHealth enabling preventative care, health problems only become worse and more expensive to fix. 

“The return on investment is hard to even quantify, but at the same time, our communities are only as strong as the people who are struggling the most,” Kuechler said. “[MassHealth is] strengthening communities through supporting services that make a huge difference in the end.”

Abigial Pritchard is a summer intern with The New Bedford Light, as part of the South Coast Internship designed for local students.