Too many people are being improperly disenrolled from the Medicaid program now that the COVID-19 public health emergency has ended, according to Biden administration officials; however, efforts are underway to re-enroll these beneficiaries.
“The work of the ‘Medicaid unwinding’ and helping people maintain coverage is the biggest policy and operational priority we have within the Medicaid world at this time, and the bottom line is we want to make sure people maintain access to healthcare coverage,” Dan Tsai, director of the Center for Medicaid & CHIP Services, said Wednesday afternoon on a phone call with reporters.
“We are very concerned about the level of terminations — meaning disenrollments — that we are seeing across the country,” Tsai continued. “In particular, we’re very concerned that the majority of people that have lost coverage, have lost coverage for what we call procedural reasons, meaning the state has not been able to identify that someone is eligible [because] individuals have not responded, and that could be due to lack of awareness, wrong addresses, or people not getting a Medicaid renewal form in the mail.”
The public health emergency ended on May 11, and states were allowed to begin the disenrollment process — also known as “coverage redetermination” — on April 1. Although Centers for Medicare & Medicaid Services (CMS) officials declined to call attention to specific states’ non-renewal numbers, Tsai said that in the U.S. overall, “for the initial set of renewals, what we were seeing was about 45% of people being successfully renewed and about a third of folks being disenrolled, with the majority of those being due to the procedural [reasons] that I mentioned.”
So far “we’ve had about a half-dozen states where we have affirmatively identified an issue and required them to pause procedural terminations and reinstate individuals and/or make other fixes,” he added. “The situation varies by state depending on what the particular issue is. And we are in discussions with probably a dozen other states, exploring a range of things that have come up; they require sometimes pulling case records and assessing what’s happening to help identify if there are violations of federal requirements.” The agency outlined in a fact sheet some of the actions it is taking.
Tsai noted that a law passed by Congress last year listed several financial penalties for states that disenrolled Medicaid recipients without first making substantial efforts to reach them. The biggest penalty is related to the higher matching Medicaid payments that states have been getting from the federal government as long as they follow the rules. “So in the instances where we have been holding states accountable and identified violations that required states to pause procedural terminations, those states understand if they do not do that, their entire enhanced federal match for the quarter is at risk.”
One of the most common issues, according to Tsai, revolves around using electronic data to automatically renew Medicaid beneficiaries. “For example, if a state had an income amount on record, they could ping it up against recent data sources and confirm that the income level is still the same,” he said. “States are required by regulation to auto-renew those folks and send those folks a notice that they’ve been successfully renewed. One of the most common things we’re seeing is that due to a range of systems glitches, the electronic data matching fails, and those individuals do not receive what they’re entitled to.”
During a question-and-answer session, CMS Administrator Chiquita Brooks-LaSure was asked what the administration did wrong that resulted in such a high percentage of people being disenrolled. “I don’t see this as a ‘What did we do wrong?’ scenario,” she replied. “I see this as a scenario where we all knew that trying to make sure that people retain coverage when we’re at record levels of enrollment was going to be a difficult process. And so that’s what we’re seeing.”
“It is indeed as difficult as many people anticipated,” she added. “And we’re all collectively going to have to work over the next 12 months to make sure that if people lost coverage who are eligible, that we get them enrolled in the right coverage. We knew and we’ve known for over a decade that people who are at these income levels, a lot changes in their lives — they lose a job, they gain a job, they move. We knew that this was going to be difficult, and it is in fact difficult. So that’s why we need everybody to do their part in the process.”
That includes providers, Tsai told MedPage Today. “We have been both partnering with and continue to call to action our partners in the private sector,” he said. That means encouraging “health plans, providers, and others to really help raise awareness with Medicaid enrollees — for example, at the point of care for healthcare providers — and to do everything in their power to actually help people complete renewal forms or get directed to the right resources on the ground.”