Dive Brief:
- The majority of states plan to take at least a year to determine who is no longer eligible for Medicaid after the COVID-19 public health emergency ends, according to new research from the Kaiser Family Foundation.
- That process, called redetermination, will kick off in April after a pandemic-era stay on the Medicaid eligibility checks. How states are approaching redetermination varies. Some states are prioritizing maintaining coverage by implementing unwinding more slowly, while other states are moving more quickly to focus on reducing budgetary costs.
- In total, 43 states plan to take between 12 and 14 months to complete renewals, to try to prevent inappropriate terminations, KFF found.
Dive Insight:
Medicaid enrollment skyrocketed during the pandemic, partially due to COVID-19 era rules requiring states to provide continuous enrollment to Medicaid beneficiaries in exchange for more generous federal funding.
Continuous enrollment will cease at the end of March. States can restart disenrolling people as early as April after fully reviewing their eligibility. How states are approaching redeterminations faces scrutiny, because the process could have major ramifications for health insurance coverage in the U.S.
KFF surveyed state Medicaid officials in January to find how states are preparing to resume eligibility checks. A number of state actions will affect continued enrollment, according to researchers. States that move more slowly increase the share of ex parte renewals and conduct more enrollee outreach and followup will increase the number of people able to retain coverage.
“Taking more time to initiate and complete the unwinding process can help to avoid overwhelming staff resources and prevent inappropriate terminations but could maintain enrollment for potentially ineligible people for longer,” researchers wrote.
States were allowed to initiate renewals as early as February, but can’t disenroll anyone before April. Yet, more than half of states are waiting until April to begin the process, while 15 started in March and eight started in February.
States that move faster, have lower ex parte rates and don't follow up with enrollees have a higher risk of coverage loss
More than two-thirds of states are considering multiple factors in prioritizing renewals, including time since last renewal and potential ineligibility. Using a hybrid approach gives states more flexibility to target potentially ineligible enrollees early in the process, and delays action on groups whose eligibility is unlikely to change, KFF said.
Meanwhile, 12 states are adopting a time-based approach, which schedules renewals based on application or last renewal date. Just two states plan to take a population-based approach, which processes renewals by eligibility groups or cohorts, KFF found.
Most states are also taking steps to increase the share of renewals completed ex parte — when states use existing data sources to check enrollees’ eligibility before reaching out to them for documentation or renewal forms. Ex parte reduces administrative burden and lowers the chance eligible beneficiaries would lose coverage because they’re unaware of, or can’t complete, the renewal process, according to researchers.
One-third of states gave KFF estimates of how many enrollees could lose coverage. On average, those states estimate roughly 18% of Medicaid enrollees will be disenrolled when the continuous enrollment provision ends, but specific estimates range from 7% to 33% of total enrollees. That’s consistent with other estimates indicating about 15 million to 18 million people could lose Medicaid coverage in the next year.
Most will likely join other coverage, but some 4 million people are expected to become uninsured as a result of redeterminations.
”It is likely that the uninsured rate will increase as states resume Medicaid disenrollments,” KFF said.
