(CNN) — Millions of Americans are at risk of losing their Medicaid coverage in the coming months, but residents of Arizona, Arkansas, Idaho, New Hampshire and South Dakota will be the first to experience the terminations.
The congress banned the states process Medicaid eligibility assessments since the covid-19 pandemic began. That ban ends Saturday, with some states moving much faster than others to disenroll those deemed ineligible for the public health insurance program for low-income Americans.
That worries advocates, who say the speed will result in eligible residents being wrongfully discharged. Also, it could make it more difficult for those who no longer qualify to switch to other types of coverage.
“This is the fable of the tortoise and the hare,” said Joan Alker, executive director of the Center for Children and Families at Georgetown University. “Taking the time will definitely result in a better outcome for eligible children and families to remain covered. So speed is a big concern.”
The five states will begin cutting coverage in April, followed by 14 more states in May and an additional 20 states, plus the District of Columbia, in June. All states must complete their redeterminations within the next 14 months.
About 15 million people could stop receiving Medicaid, according to various estimates, although several million people could find coverage elsewhere. Others may still be eligible, but could be dropped for procedural reasons, such as not completing renewal forms. People who are at risk include at least 6.7 million childrenaccording to a Georgetown analysis.
registrations on the rise
Medicaid enrollment has skyrocketed since March 2020, when lawmakers passed the Families First Coronavirus Response Act, which prevented states from involuntarily removing anyone from health coverage. In return, Congress boosted states’ Medicaid match rates by 6.2 percentage points.
The provision was initially tied to the national public health emergency, but lawmakers changed it as part of the federal spending bill that passed in December. In addition to being able to start making terminations in April, states will receive enhanced federal matching for the remainder of this year, though it will be phased out over time.
More than 92 million Americans enrolled in Medicaid and Children’s Health Insurance Program (CHIP) in December, up 31% from February 2020, according to the most recent data available from the Centers for Medicare & Medicaid Services (CMS).
Reviewing the eligibility of all those enrollees will be a monumental task for state Medicaid agencies, many of which also face staff shortages. To prepare, they will be hiring new employees, temporary workers or contractors or bringing back retirees, according to a recent survey by Georgetown and the Kaiser Family Foundation.
Senator Elizabeth Warren speaks about the Medicare expansion and reconciliation package during a press conference with other lawmakers at the U.S. Capitol on Sept. 23, 2021 in Washington (Photo by Kevin Dietsch/Getty Images)
Most states can automatically renew coverage for at least some of their enrollees using other data, such as state wage information. But agencies must reach out to others in their Medicaid programs, which proved challenging even before the pandemic. Most states use several methods to update member contact information, including working with insurers that provide Medicaid coverage to residents.
If mailed notices are returned, states must make a good faith attempt to contact affiliates through at least two other methods before terminating them. And states must meet additional requirements to continue to qualify for enhanced matching. If they don’t, CMS could also suspend their terminations, require them to take corrective action, or impose monetary penalties.
Of the estimated 15 million people who could lose Medicaid coverage, about 8.2 million will no longer qualify, according to a Department of Health and Human Services (HHS) analysis released in August. Some 2.7 million of these people would qualify for enhanced federal subsidies for Affordable Care Act (ACA) policies that could lower their monthly premiums to $0.
However, some 6.8 million people will be disenrolled even if they remain eligible.
Faster timeline for some states
Although the federal government has given states more than a year to conduct eligibility reviews and terminations, some plan to act much faster.
Idaho, which has been monitoring member eligibility throughout the pandemic, plans to complete its reassessments by September, one of the fastest timelines in the country.
Of the nearly 450,000 Idahoans in the program, about 150,000 of them do not qualify or have not been in contact with the state in the last three years. The state began sending notices in February to those facing termination. People have 60 days to respond before they are terminated.
Those who are not eligible have 60 days from the date of completion to enroll in the state program Your Health Idaho. The program receives information nightly from the state Medicaid agency about residents who no longer qualify for public coverage but may be eligible for federal subsidies for Affordable Care Act policies.
The program contacts those people weekly while they still have Medicaid and then every 15 days during the two-month special enrollment period through various methods, including mail, email and text messages, said Pat Kelly, executive director. from Your Health Idaho.
They work with 900 agents, brokers and enrollment counselors who can help people enroll in policies. And he plans to launch an ad campaign this month highlighting the hefty subsidies. “We really need to help Idahoans know and understand that there are low-cost options available, and more importantly, that it’s comprehensive health insurance that they can get for $0 a month,” Kelly said.
Still, advocates in Idaho are concerned that the state’s push will result in eligible residents losing coverage.
Many people don’t know they must once again prove they qualify, and the state agency is understaffed and underfunded, said Hillarie Hagen, health policy associate with Idaho Voices for Children. Renewal letters may not reach members, and those who need help may not be able to reach customer service.
“We are very concerned that families, and particularly children, will lose health coverage without their knowledge, which they will find out when they go to the doctor,” Hagen said.
Knowing that many people are unaware that they will have to renew their eligibility, the Arizona Medicaid agency last summer sent text messages, letters and made robocalls to enrollees asking them to update their contact information. It is also working with community partners, healthcare providers, pharmacies and insurers. And he’s stepping up another text message campaign, said Heidi Capriotti, public information officer for the Arizona Health Care Cost Containment System.
While the state can automatically re-determine the eligibility of about 75% of its Medicaid participants, it has yet to connect with about 670,000 residents who could lose coverage because they are no longer eligible or have not responded to Medicaid applications. agency. The state plans to take 12 months to assess whether its members still qualify.
Don’t wait for Medicaid expansion to begin
South Dakota will begin disenrolling Medicaid enrollees in April, though some low-income adults may become eligible again in July, when the state Medicaid expansion program.
Voters approved expanding Medicaid to low-income adults at the polls in November, despite objections from the Republican governor and legislature.
Nearly 152,000 residents signed up for Medicaid in January, an increase of more than 30% from March 2020, according to the state Department of Social Services. But more than 22,000 people appear to be currently ineligible.
The agency said in an FAQ that it will prioritize review of people who are likely to be ineligible because they no longer meet a coverage group or their income has increased, among other reasons.
Those who are not eligible will be disenrolled with a 10 day notice. If they seem eligible for the expansion in July, they will receive a notice about it when they are terminated and a reminder will be sent to them in June. The agency encourages ineligible members to reapply after the Medicaid expansion takes effect.
Lidia Vilorio, a home health aide, gives her patient Martina Negrón her medicine and cookies for her tea on May 5, 2021 in Haverstraw, New York. (Photo by Michael M. Santiago/Getty Images)
But that three-month gap can wreak havoc on the health of low-income residents, said Jen Dreiske, deputy director of South Dakota Voices for Peace, which works with immigrants and refugees in the state to educate them on the solution. These people may have to go without their heart medications or cancer treatment. They may also be afraid to go to the doctor because of the cost.
“Why can’t we wait until July 1?” Dreiske said. “Our concern is that people will get sick or die because they won’t be able to access much-needed medical care.”