States show significant variation in Medicaid redeterminations

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There's significant variation among states when it comes to the ongoing Medicaid disenrollment process. A new Robert Wood Johnson Foundation analysis has found that while enrollment in Medicaid and the Children's Health Insurance Program (CHIP) declined by 9 million people from April to November 2023, eight states had Medicaid disenrollments surpassing 100% of projected net disenrollments.

Nationwide, aggregate net disenrollment as of November 2023 was at 60.5% of projected total disenrollment throughout the unwinding. The eight states exceeding 100% are Arkansas, Idaho, Iowa, Montana, New Hampshire, Oklahoma, South Dakota and Texas.

At the same time, 19 states had net disenrollment of 50% or less of the firm's projected total net disenrollment.

The net disenrollment rate was much higher for children than adults nationwide, largely because of exceptionally high child net disenrollment in some states. Total net disenrollment among children was 84.2% of the expected total, while total net disenrollment among adults was 50.7% of RWJ's estimates.

Seven states had adult net disenrollment greater than 100% of expected disenrollment, while 12 states had child net disenrollments that exceeded that threshold. This means current Medicaid enrollment levels in these states are below the historical trend, the report found.

States that publicized their intention to complete the unwinding in less than 12 months, states that obtained few federal waivers to streamline renewal, and states that prioritized the renewal of those likely to be ineligible all had notably higher overall net disenrollment rates relative to other states. States with any of these three characteristics had net child disenrollment over 120% of the projections, on average.

WHAT'S THE IMPACT?

In 2020, Congress passed the Families First Coronavirus Relief Act, which barred states from disenrolling people from Medicaid or child Medicaid coverage funded through CHIP during the pandemic unless they requested it. This led to record-high enrollment growth of more than 20 million Medicaid members than before the requirement.

Three years later, Congress passed legislation to end the continuous coverage requirement effective March 31, 2023, and allowed states to resume the Medicaid eligibility redetermination process, also known as Medicaid "unwinding."

Some are concerned that states are moving too fast and that many enrollees could lose coverage for procedural reasons even though they remain eligible. Others argue that slowing down the unwinding leaves ineligible people on the rolls at an unnecessary cost to both state and federal budgets.

The results from the analysis are likely to change when more recent data becomes available, particularly as more states complete the unwinding process, originally scheduled to end in June. Some variation between states may be because of their different start dates, authors said.

THE LARGER TREND

Data published by KFF in January showed an estimated 16 million beneficiaries had lost Medicaid coverage to that point. 

There are reasons to expect disenrollment rates to moderate in the second half of the unwinding as states reduce procedural disenrollments and work through "likely ineligible" populations, the report said.

To date, 40 states and the District of Columbia have adopted Medicaid expansion, and 10 states have not adopted the expansion, according to a KFF report in December 2023. Originally a mandate of the ACA, Medicaid expansion was left to the determination of individual states following a ruling by the Supreme Court.

In the 10 states that have not adopted Medicaid expansion, nearly 1.5 million uninsured individuals fall into the "coverage gap," and are not eligible for Medicaid or ACA Marketplace subsidies, KFF said.
 

Jeff Lagasse is editor of Healthcare Finance News.
Email: jlagasse@himss.org
Healthcare Finance News is a HIMSS Media publication.