Dive Brief:
- In April, more than 2 million people on Medicaid went through the redeterminations process as states resumed checking eligibility for the safety-net coverage, according to new CMS data released Friday.
- Of those, one-third had their coverage terminated. The large majority — almost 80% — lost Medicaid coverage for procedural reasons. Almost 21% of those who lost coverage were deemed ineligible.
- The data brings total estimated Medicaid disenrollments to over 3.8 million, according to the KFF.
Dive Insight:
The highly-anticipated data from the CMS is for the 18 states that renewed at least one cohort of Medicaid beneficiaries in April.
Of those, almost 46% of beneciaries had their coverage renewed, while 22% of beneficiaries’ renewals are pending.
Typically, roughly 17 million people lose Medicaid or Children’s Health Insurance Plan coverage each year. But this year, redeterminations are a whole different beast. States’ experience with conducting Medicaid eligibility checks has atrophied during COVID-19, when redeterminations were paused.
Overall, more than 15 million people are expected to be removed from Medicaid during redeterminations, according to government estimates. More than six million could end up fully uninsured, reversing coverage gains during the pandemic.
Redeterminations kicked off in April. States are taking different approaches to the process, with some like South Carolina beginning renewals with individuals they believe are unlikely to be eligible, some like Virginia beginning with their general population and others like Oklahoma sorting members into high- and low-risk populations.
Twenty-nine states have a mostly automated system for processing renewals, according to the KFF. Just 18 are completing most of their renewals through the ex parte process, where states automatically confirm eligibility using available data.
Regulators and patient advocates have raised concerns about the high level of procedural terminations, where enrollees lose coverage for administrative issues like not returning renewal forms or submitting incomplete information.
The new CMS data pegging the nation’s procedural disenrollment rate at 80% is higher than other, more recent estimates.
Curbing procedural disenrollments has been a focus of the Biden administration, which released policy flexibility earlier this year meant to help states reduce the terminations through steps like allowing managed care plans to help beneficiaries complete their renewal forms.
Earlier this month, CMS regulators said they had paused disenrollments in 12 states to address issues causing procedural disenrollments. In some states, tens of thousands of people have been reinstated to Medicaid rolls following CMS’ intervention, Dan Tsai, director of the Center for Medicaid and CHIP Services, said on a press call.
Most individuals who lost coverage for procedural reasons can have it reinstated if they provide state regulators with missing information within 90 days. Managed care companies have said they have high expectations for people regaining coverage in that window.
The CEO of Medicaid managed care company Molina said recently the payer expects the number of those “reconnects” to be “actually quite high.”
Payers are also expecting to regain lost Medicaid lives through plans on the Affordable Care Act exchanges, though it’s very early to tell the extent to which those transitions are taking place.
Nearly 44,000 consumers who had previous Medicaid or CHIP coverage chose plans on Healthcare.gov in the 14 states that use the government website that completed renewals in April, according to the CMS data.
Nearly 10,000 additional people made state-based marketplace plan selections that month.
Regulators don’t expect to see redeterminations’ full impact on individual market coverage for several months.
The CMS plans to update the data on a monthly basis.
