Half a million children and families will regain Medicaid coverage
At least 7.1 million Medicaid enrollees have been disenrolled as of September 20, according to KFF.
Photo: The Good Brigade/Getty Images
Half a million children and families will regain their Medicaid and Children's Health Insurance coverage due to improper disenrollment, according to the Centers for Medicare and Medicaid Services.
On August 30, CMS issued a call to action to states about a potential state systems issue related to automatic renewals that was causing individuals to be inappropriately disenrolled from Medicaid, even when the state had information indicating the person remained eligible.
Federal rules require states to use information already available to them through existing reliable data sources, such as wage data, to determine whether people are still eligible for Medicaid or CHIP. Auto-renewals make it easier for people to renew their Medicaid and CHIP coverage, helping to make sure eligible individuals are not disenrolled due to red tape, CMS said.
CMS's call to action was sent to all states, the District of Columbia, Puerto Rico and the U.S. Virgin Islands requiring them to determine and report whether they had a systems issue that inappropriately disenrolled children and families.
Thirty reported having this systems issue, according to a CMS summary of the individual states. As a result, all 30 states were required to pause procedural disenrollments for impacted people unless they could ensure all eligible people were not improperly disenrolled.
Nearly 500,000 children and other individuals who were improperly disenrolled from Medicaid or CHIP will regain their coverage, and many more are expected to be protected from improper disenrollment going forward, CMS said.
WHY THIS MATTERS
At least 7.1 million Medicaid enrollees had been disenrolled as of September 20, based on data from 48 states and the District of Columbia, according to KFF's Enrollment and Unwinding Tracker.
During the COVID-19 public health emergency, states received increased federal funding to keep Medicaid beneficiaries continuously enrolled in the program. States began Medicaid redeterminations on April 1, ahead of the May 1 expiration of the PHE.
States took different approaches to unwinding, according to the Center on Budget and Policy Priorities. All states reported operations data for May, showing a wide range of application processing timelines, call center wait times and call center abandonment rates, the September 15 report said. Data showed troubling trends from the 36 states that had begun unwinding-related terminations as of May, including the fact that 29% percent of all enrollees due for renewal had their eligibility terminated for a procedural reason, and procedural terminations accounted for 77% of all terminations.
THE LARGER TREND
The loss of coverage for Medicaid recipients happened faster than anyone believed it would, Karen Shields said in June. Shields is chief client engagement officer at Gainwell Technologies, a large payer of Medicaid claims, and a former deputy director for the Center for Medicaid and CHIP Services.
"The call for action indicates everyone thinks it's faster," Shields said at the time.
The call to action was in the form of a letter sent in June by Health and Human Services Secretary Xavier Becerra to governors urging them to adopt new flexibilities to minimize avoidable Medicaid coverage losses.
Through the August call to action CMS said it would continue to provide technical assistance to states as they address system issues.
Throughout the renewals process, CMS has offered states many strategies to assist them in making it easier for people to renew their coverage. Nearly all states have adopted at least some of these strategies.
Additionally, to help make transitions from Medicaid to other health coverage options more accessible, CMS has launched national marketing campaigns and made available Special Enrollment Periods through HealthCare.gov, state-based marketplaces and Medicare.
ON THE RECORD
"Thanks to swift action by HHS, nearly half a million individuals, including children, will have their coverage reinstated, and many more will be protected going forward. HHS is committed to making sure people have access to affordable, quality health insurance – whether that's through Medicare, Medicaid, the Marketplace, or their employer," said HHS Secretary Xavier Becerra. "We will continue to work with states for as long as needed to help prevent anyone eligible for Medicaid or CHIP coverage from being disenrolled."
"Medicaid and CHIP are essential for millions of people and families across the country," said CMS Administrator Chiquita Brooks-LaSure. "Addressing this issue with auto-renewals is a critical step to help eligible people keep their Medicaid and CHIP coverage during the renewals process, especially children. CMS will keep doing everything in our power to help people have the health coverage they need and deserve."
Twitter: @SusanJMorse
Email the writer: SMorse@himss.org
