When state Medicaid demonstrations end: projected eligibility loss after a MassHealth housing support program transition

TL;DR

A new Medicaid housing support program in Massachusetts will likely exclude many people, potentially affecting those with health conditions the most.

Contribution

The study projects eligibility loss after a Medicaid housing support program transition using administrative data.

Findings

68% of individuals enrolled from 2021 to 2024 would no longer qualify under updated 2025 eligibility criteria.

Those remaining eligible tend to be older with more chronic conditions and higher healthcare use.

Eligible and ineligible groups show similar rates of opioid use disorder and mental illness.

Abstract

Massachusetts Medicaid (MassHealth) transitioned a Section 1115 waiver-based housing support program to a permanent program in 2025, implementing new eligibility restrictions.

We projected the potential impact of these new eligibility restrictions using linked administrative claims and programmatic data.

Among individuals enrolled from 2021 to 2024, 68% would no longer qualify under updated 2025 criteria. Those projected to remain eligible were older and had more chronic conditions and higher healthcare utilization than those projected to be ineligible, but similar prevalence of opioid use disorder and mental illness.

These findings highlight the potential for unintended consequences in eligibility prioritization stemming from operational shifts in Medicaid waiver-based programs.

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