More than half a million already disenrolled during Medicaid redeterminations

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States have begun to unwind the COVID-19 emergency continuous enrollment provision and resumed Medicaid disenrollments, and early data shows that more than half a million enrollees have already been disenrolled, with close to 250,000 in Florida alone.

According to KFF, not all states have publicly posted their numbers, but in nine states that reported both total completed renewals and total disenrollments, the disenrollment rate ranges from 54% in Florida to just 10% in Virginia. Among these states, the median disenrollment rate is 34.5%.

The data also shows high rates of "procedural disenrollments," in which people are disenrolled because they didn't complete the enrollment process, and may or may not still be eligible for Medicaid. That rate exceeds 80% in Arkansas, Indiana, Florida and West Virginia, and was nearly 55% in Iowa.

The high rate of procedural disenrollments, said KFF, indicates that many of the people whose coverage was terminated likely remain eligible for Medicaid, a concerning trend among those who did not have a change in income or circumstance that would make them ineligible.

WHAT'S THE IMPACT?

This early in the redetermination process, the data picture is still incomplete. That, according to KFF, means the picture of how the process is unfolding is still evolving. An important question to ask as more data becomes available is whether variation in how states prioritize renewals drive these early differences in disenrollment rates.

In some states, including Arkansas, Idaho, Iowa, and Florida, early renewals are largely among people the states think are no longer eligible or who did not respond to renewal requests while the continuous enrollment provision was in place. These states generally have higher disenrollment rates compared to other states (except for Iowa). 

Other states, like Indiana, Nebraska and Virginia, have instead adopted a time-based approach, where they conduct renewals based on an individual's renewal date. And still other states, such as Arizona, are including a mix of people they think are no longer eligible along with those whose scheduled renewal date is in the reporting month.

Since procedural reasons are driving such high disenrollment rates, there's a chance that some beneficiaries who still qualify for Medicaid could churn back into the program; research indicates that about 10% of Medicaid enrollees churn in a normal year, while another KFF analysis focused on children found that disenrollment and churn are higher at annual renewal. And most people who lose Medicaid coverage experience a period of uninsurance before re-enrolling in Medicaid.

Some states are taking steps to minimize procedural disenrollments, KFF found. For example, Idaho paused procedural disenrollments in April because of a technical issue, and Iowa is holding open cases to do a "safety check" to ensure that they don't overlook any documents that have been submitted.

It's still uncertain how the Centers for Medicare and Medicaid Services will respond. CMS opened a special enrollment period from March 31 through July 31 for those who no longer qualify for Medicaid. But many of those no longer on Medicaid still qualify for the program.

The agency is working with states to address compliance issues, KFF said, and does have the authority to require states to pause procedural disenrollments if they don't take corrective action to address compliance issues.

THE LARGER TREND

An earlier KFF survey, published in May, showed about two-thirds (65%) of all Medicaid enrollees say they are "not sure" if states are now allowed to remove people from Medicaid if they no longer meet the eligibility requirements or don't complete the renewal process, with an additional 7% incorrectly saying states will not be allowed to do this.

Three in four adults 65 and older say they're unsure if states are allowed to remove people from Medicaid, and Black adults are more likely than white adults to incorrectly say that states will not be allowed to do this. Just under three in ten (28%) overall are aware states are now allowed to remove people from Medicaid.

Part of the confusion may stem from the fact that almost half of enrollees said they've never been through the Medicaid renewal process before. That includes two-thirds (68%) of Medicaid enrollees who are 65 and older and more than half of Medicaid enrollees who are between the ages of 18 and 29 (53%).
 

Twitter: @JELagasse
Email the writer: Jeff.Lagasse@himssmedia.com