Will more states press pause on Medicaid disenrollments?
By Rachel Roubein and McKenzie Beard / June 29, 2023
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Today’s edition: The Justice Department cracks down on health-care fraud. A federal judge in North Carolina weighs whether to block parts of the state’s 12-week abortion ban set to go into effect Saturday. But first …
July is a big month for the Medicaid program
It’s no secret: Biden officials are concerned over how states are unwinding their Medicaid rolls.
Just over two weeks ago, the federal health department granted states several new actions they could take to minimize undue coverage losses as the pandemic-era policy preventing people from losing Medicaid came to an end this spring.
Since then, at least one state — Michigan — announced it was taking up the government’s offer to impose a one-month delay on terminating certain people from the safety-net program who don’t return the necessary paperwork, giving state officials more time to conduct additional outreach.
Other states may follow suit. Roughly 10 more states are potentially interested in doing so, though they’re still in the throes of evaluating the move, according to Kate McEvoy, the executive director of the National Association of Medicaid Directors.
The intense focus — and concern — around determining who’s no longer eligible for the program comes ahead of several high-stakes moments for the Medicaid program next month. By July, nearly all states will have begun kicking people off the program, which saw enrollment grow by more than 20 million people during the pandemic.
And other changes are coming in two states: South Dakota will begin covering tens of thousands more low-income people under Obamacare’s Medicaid expansion, and Georgia is slated to launch the nation’s only Medicaid work requirement.
The Great Medicaid Unwinding
At least 1.5 million people have been cut from the Medicaid program since states were allowed to resume eligibility checks in April. That’s according to KFF, which analyzed the latest publicly available data from 26 states and D.C.
Roughly 73 percent of terminations occurred for procedural reasons among states reporting this breakdown. That can happen when people who may still be eligible for Medicaid never receive mail from the state or fail to return verification forms. But there’s a wide variation in rates of procedural disenrollments, and federal officials are particularly concerned about places where these rates are high.
That prompted the Centers for Medicare and Medicaid Services earlier this month to give states several new options aimed at curtailing avoidable coverage losses. That included the month-long delay on administrative terminations, as well as letting managed-care plans assist people with completing their renewal forms and allowing pharmacies to facilitate reinstating coverage.
Sara Lonardo, a CMS spokesperson, said several states have taken up some of the new flexibilities. The agency is in the process of providing technical assistance to other states that have expressed an interest. (No other additional details, such as which states, were immediately provided.)
Medicaid advocates are urging states with high rates of coverage losses for procedural reasons to pump the brakes. “I think taking a pause is a necessary step, and then during that time, the state needs to really figure out why they’re having such high procedural terminations,” said Garrett Hall, a policy analyst at Families USA, a left-leaning consumer health lobby
Other Medicaid changes loom
Saturday is a big day for Medicaid in two states.
South Dakota will officially extend the health insurance program to roughly 52,000 more people. Voters in the red state were the latest to approve Obamacare’s Medicaid expansion, doing so with 56 percent approval at the ballot box in November.
In June, the state began enrolling newly eligible people in Medicaid. Coverage kicks in on Saturday.
South Dakota was one of the first states to begin purging its Medicaid rolls. That’s leading to a complex scenario for Medicaid advocates, who are now tasked with helping to find those who lost coverage just weeks ago and assisting them with re-enrolling in the program now that they’re eligible again.
The state’s Department of Social Services screened for those who could regain coverage under Medicaid expansion and sent a special notice at the time their Medicaid coverage was terminated. The department will also do further outreach to that same group in July, Matt Althoff, the DSS secretary, said in a statement to The Health 202.
The situation is different in Georgia. We dove into our colleague Amy Goldstein’s recent piece on the state yesterday, but it’s worth repeating because what happens in Georgia will be closely watched across the country.
The state’s program will go into effect Saturday after years of delay. Under Republican Gov. Brian Kemp’s plan, Georgia will partially expand Medicaid up to the federal poverty line. Those newly enrolled will be required to work, go to college or volunteer to keep their coverage — a policy beloved by Republicans, despised by Democrats and that’s not in place anywhere else in the country.
It’s unclear how many people the new program will cover. But Medicaid advocates contend many more would gain coverage if Kemp ended his refusal to implement Obamacare’s broader expansion.