Community health centers grappling with high Medicaid disenrollment
CHCs report that Medicaid disenrollment has affected patients across all ages, including those with major health needs.
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Nearly 95% of community health centers (CHCs) have reported that patients have been disenrolled from Medicaid, and among those reporting disenrollment, an estimated 23% (nearly one in four patients) have been disenrolled, according to a new survey from the National Association of Community Health Centers and the George Washington University's Geiger Gibson Program in Community Health.
This figure is slightly higher than the Medicaid disenrollments of 20% reported as of March 2024, and within the range of up to 28% estimated in recent projections.
CHCs report that disenrollment has affected patients across all ages, including those with major health needs, with two-thirds of those disenrolled (63%) also experiencing significant disruptions in care. Nearly half (49%) reported that patients lost access to managed care specialty, hospital or other care needed outside the health center, while half reported that patients had missed their scheduled appointments, or that patients had discontinued or postponed ongoing treatment.
Nearly one-third (32%) of patients who were disenrolled were patients of all ages with disabilities, a group in particular need of specialized health services that fall outside the capabilities of many health centers. And an estimated 12% of those disenrolled were patients with chronic conditions, while 12% were older adults over the age of 65, and nearly one quarter (24%) of disenrolled patients were children.
In ACA non-expansion states, health centers report that 40% of disenrolled patients were children – two in five disenrolled patients – compared to 20% in Medicaid expansion states that insure all low-income working-age adults. While the reasons for this are unclear, one possibility is that far more adults in non-expansion states presumably had no continuing coverage pathway once continuous coverage ended, meaning that far more children would have been affected where states failed to separately and independently review children's eligibility.
Meanwhile, navigating the renewal process poses significant problems. CHCs reported a wide range of problems encountered by their patients: Nearly all CHCs reported that patients had significant difficulty with the Medicaid redetermination process, and either were not notified, or else failed to understand the process, the actions that might be required of them, or how to respond to the coverage renewal process.
Significantly, 85% reported that patients did not understand the renewal notice. Nearly two thirds (62%) reported that patients failed to receive a renewal notice; nearly 70% reported that patients experienced general difficulty navigating the state website; two thirds reported that patients had to make multiple attempts to renew coverage; more than half reported that patients could not connect to a call center; over two in five reported that patients could not log into the state portal; and nearly one third of all CHC respondents reported that patients received incorrect or conflicting information from the call center.
WHAT'S THE IMPACT?
On April 1, 2023, states began the largest planned Medicaid enrollment reduction ever undertaken. By the end of March 2023, Medicaid enrollment had grown nationally to 94 million people, reflecting the impact of continuous enrollment on the problem of Medicaid churn, which happens when beneficiaries bump up against the program's strict eligibility rules. For three years, continuous enrollment paused churn; the unwinding process effectively reinstated it.
By March 2024, even with several months remaining before the unwinding completion date, Medicaid disenrollments had surpassed 19.2 million beneficiaries, including 4.76 million children. Moreover, procedural disenrollments now account for 70% of all disenrollments, especially in states in which the streamlined ex parte renewal system instituted by the Affordable Care Act failed to function, according to survey authors.
Care disruption is considerable for disenrolled patients, and perhaps most striking for disabled people, those with chronic conditions and children, who constitute 40% of disenrolled CHC patients in states that have not adopted the ACA expansion.
THE LARGER TREND
If these coverage loss estimates remain consistent as unwinding continues into 2024, CHCs can expect that more than 3.5 million patients will experience coverage disruptions, the survey found.
Similarly, if the low reenrollment rate remains constant, then three-fourths of all patients losing Medicaid will remain disenrolled, leading to disruption, not only in coverage, but in care itself, along with substantial revenue loss that will further affect ongoing CHC operations.
Perhaps most concerning to the authors is the disruption in pediatric coverage, as well as care for the highest-need patients, including those with chronic conditions or disabilities. This suggests that, going forward, there is an enormous need for especially intensive focus on these particular populations by states and health centers alike.
Jeff Lagasse is editor of Healthcare Finance News.
Email: jlagasse@himss.org
Healthcare Finance News is a HIMSS Media publication.
