Medicaid drops another 13,000 Mississippians as agency’s backlog snowballs
Nearly 13,000 Mississippians were kicked from Medicaid’s rolls in September during the most recent batch of disenrollments, while the agency’s backlog grows.
The latest numbers bring the state’s total disenrollments to 81,454 people, most of whom were dropped for paperwork issues, not because they were found to be ineligible.
Medicaid divisions all over the country are reviewing their rolls for the first time in three years after the end of federal regulations that prevented state Medicaid agencies from disenrolling beneficiaries during the pandemic. Prior to this process, referred to as “unwinding,” Mississippi Medicaid enrollment exceeded 900,000 people for the first time in the agency’s history.
Many of them have been children, according to the agency’s monthly enrollment reports. Federal research predicts that kids are most at risk of losing benefits during unwinding, and it’s not clear how many are being dropped despite being eligible. Before the terminations began, children in low-income families made up more than half of the state’s Medicaid rolls.
Almost 45,000 kids in Mississippi have been dropped from Medicaid since the start of unwinding.
Though Medicaid’s spokesperson Matt Westerfield previously told Mississippi Today that the agency hopes to increase its ex-parte rate, or automatic renewal rate, the state continues to disproportionately drop beneficiaries for procedural reasons, which means their paperwork was either not turned in on time or it was incomplete.
Of the 12,828 people dropped in September, around 75% were procedural disenrollments. Overall, Mississippi reports a 78% procedural disenrollment rate thus far. According to KFF, 72% of all people disenrolled were terminated for procedural reasons across all states with available data.
And though it appears in recent data that Mississippi’s disenrollments are decreasing, that’s because the agency’s backlog is growing.
During the first round of disenrollments completed in June, Mississippi Medicaid didn’t get around to checking the eligibility of 5,892 people that were due for the review. However, that backlog has significantly increased — to 19,402 in July; 29,788 in August and now 45,989 in September.
Westerfield did not reply to questions by press time.
As Republican Gov. Tate Reeves continues to voice his opposition to Medicaid expansion, which would insure thousands more working Mississippians, unwinding is set to continue for months. Thousands more Mississippians are poised to lose Medicaid coverage amid a statewide health care crisis — nearly half of the state’s rural hospitals are at risk of closure, according to one report.
KFF says at least 8,696,000people nationally have been dropped from Medicaid as of Oct. 11.
Oklahoma health agency gets grant to support new mothers during Medicaid unwinding
The Oklahoma State Department of Health received about $170,000 to support new mothers and their families during the Medicaid redetermination process.
‘These are not good numbers’: Thousands more Mississippians, kids dropped from Medicaid
More than 16,000 Mississippians were dropped from Medicaid in August during the latest round of the agency’s disenrollments.
The pandemic-era federal regulations that prevented state Medicaid agencies from disenrolling beneficiaries ended in May. Since then, Medicaid divisions all over the country are reviewing their rolls for the first time in three years.
August’s numbers bring the agency’s total number of disenrollments thus far to 68,626 people. Before unwinding began, the agency’s enrollment exceeded 900,000 people for the first time in the agency’s history.
Most concerningly, most of those who were disenrolled — 54,366 people or 79% — have not been kicked off because they’re ineligible. Instead, there were issues with their paperwork – it was either not turned in on time or was incomplete. That could mean some people have been kicked off Medicaid even though they’re still eligible.
It’s unknown how many of the procedural disenrollments have been children. Children are most at risk of losing benefits during the unwinding process, federal research predicts, and many of them may still be eligible. Kids in low-income families comprise more than half of Mississippi’s overall Medicaid beneficiaries.
“These are not good numbers,” said Joan Alker, executive director of Georgetown University’s Center for Children and Families. “It’s very concerning to see … people, likely children and parents by and large, losing Medicaid for red tape or procedural reasons.”
Mississippi Today has requested to interview an agency official about the unwinding data, but the requests were not granted.
New enrollment numbers show that from July to August, another 12,882 children were dropped, bringing the agency’s total of children dropped since unwinding began to 31,592.
Mississippi Medicaid’s monthly unwinding reports do not say what number of terminations were children, but Mississippi Medicaid spokesperson Matt Westerfield confirmed that most of these disenrollments are due to unwinding.
The agency’s ex-parte rate, or automatic renewal rate, remains low. Westerfield previously told Mississippi Today that the agency wants to increase those rates, but August numbers show that of the 70,069 people up for renewal, only 10,817 were renewed on an ex-parte basis.
That’s on par with the previous data release, which shows that of the 75,110 people up for renewal in July, 12,188 were renewed ex-parte.
The agency in August requested permission from the Centers for Medicare and Medicaid Services for “four additional flexibilities that would reduce procedural disenrollments while increasing ex-parte renewals.” According to Westerfield, some were approved, while discussions continue about the others.
The agency’s backlog of beneficiaries to review also keeps growing. In June, about 5,000 renewals were not reviewed. About 15,000 additional reviews went uncompleted in July and another 10,000 in August.
As unwinding continues for the next several months, the burden on the state’s already crumbling health care infrastructure grows. One report puts nearly a half of the state’s rural hospitals at risk of closure.
State Republican leaders have adamantly opposed expanding Medicaid to the working poor, which research shows would bring in billions, though presumptive incoming House Speaker Jason White recently indicated he would consider expansion. His predecessor Philip Gunn largely led the effort to oppose the policy change.
Federal regulators flag ‘concerns’ as Montana cuts Medicaid rolls
Federal regulators are urging Montana health officials to fix shortcomings in the state’s Medicaid redetermination process, expressing “concerns” that the state may be disenrolling people who are eligible for the public health insurance and creating barriers for others through long wait times at call centers and during the application process.
The state began reassessing the eligibility of the more than 320,000 people on Montana Medicaid in April with the lifting of the federally-designated COVID-19 public health emergency, which barred states from removing people from the program during the pandemic. The state has since reported removing 34,204 people from the rolls in April and May, roughly half of all people reviewed. Data for June is still pending.
In an August 9 letter addressed to Montana’s Medicaid Director Mike Randol, an official with the Centers for Medicare and Medicaid Services (CMS) said the state’s May data showed an average call center wait time of 42 minutes and an average call abandonment of 40%. Those metrics are among the worst in the country — only Missouri had a longer average wait time of 48 minutes and a slightly higher drop rate. Nevada had a dropped call rate of 56%.
The federal agency also flagged the 36% of Montanans reviewed in May who lost coverage because of procedural errors such as failing to return paperwork or submit all the required information. Many of those individuals, including children, could still be eligible for the health insurance program, the letter said.
“While CMS expects procedural terminations, a high rate of procedural terminations may indicate that beneficiaries may not be receiving notices, are unable to understand them, or are unable to submit their renewal through the required modalities,” the agency said.
The letter also indicated that 15% of the income-based applicants who recently applied for Medicaid took the state longer than 45 days to process, “exceeding the regulatory requirements.” The notice said that expeditious processing of new applications, including some who may be re-applying after realizing they lost coverage, was “imperative.”
Out of 50 states that received letters about their recent data, the news site Politico reported that thirty-six were notified of at least one concern about call center wait times, application processing, or procedural disenrollments. Only five states — Montana, Florida, Rhode Island, Alaska and New Mexico — were dinged for all three categories.
In response to a request for comment on the federal letter, Department of Public Health and Human Services spokesperson Jon Ebelt said Friday that the department has been trying to simplify the phone tree options at call centers, adjust staffing levels and modifying its call-back protocol to prioritize enrollees who are most at risk of losing coverage. The department will also be starting a public service announcement campaign “in the coming weeks” that Ebelt said would run through the duration of the redetermination process, slated to end in January 2024.
“CMS sent helpful feedback to states this week,” Ebelt said. “We continue to closely monitor, evaluate, and strengthen our Medicaid redetermination process with a laser focus on ensuring coverage for eligible Montanans.”
The health department in November awarded a more-than-$2.25 million contract to Public Consulting Group LLC, a private contractor, to boost staffing levels for processing Medicaid renewals. On its website, PCG said it has allocated 40 staff to the contract.
Asked how the recent disenrollment and call center data highlighted by CMS reflect Gov. Greg Gianforte’s stated commitment to “customer service” from state agencies, Deputy Communications Director Brooke Metrione said the governor “has full confidence in DPHHS as it undertakes the overdue Medicaid redetermination process, ensuring eligible Montanans maintain their coverage while guarding against fraud, waste, and abuse of taxpayer resources.”
In recent months, advocates for Medicaid enrollees and Democratic lawmakers have called on Gianforte and the health department to pause redeterminations until the state can resolve issues leading to high rates of procedural terminations. The Montana Budget and Policy Center and Montana Women Vote, groups that lobby on behalf of low-income Montanans, reiterated that stance in a July letter to CMS. The outreach recounted reports of long call center wait times, confusion about the process and sudden disenrollments.
“Given the serious and endemic nature of these issues, we believe that the large number of Montanans being disenrolled includes a high percentage of people who have not had a fair and timely redetermination process and who may still be eligible for coverage. We believe the state should consider pausing or slowing the rate of redetermination until these issues can be addressed,” the letter said. One of the signatories was Rep. SJ Howell, D-Missoula, who works as executive director of Montana Women Vote.
In addition to the 71,930 enrollees reevaluated in April and May, the department began reevaluating the eligibility of another 38,372 people in June, according to its public dashboard. About 21% of that group had had their coverage renewed as of the dashboard’s last update in mid-July. Other applications are still being processed and roughly 45% of people under review hadn’t responded to the department’s requests for information.
The department has said it plans to update the dashboard once a month.
Editor’s note: This story was updated on Aug. 11 to include a response from the state health department.
Hundreds lose Wyoming Medicaid and Kid Care coverage
More than 450 people have so far lost health coverage through Wyoming Medicaid or Kid Care CHIP as the state moves away from pandemic-era measures, the state health department reported at the end of June. Thousands more are expected to lose coverage over the next nine months.
The largest factors in losing eligibility were age, residency and income, according to Wyoming Department of Health spokesperson Kim Deti.
The health department has estimated that between 10,000 and 15,000 residents could lose access to Medicaid programs this year as it conducts a yearlong renewal process. Some free medical clinics expect the increase in uninsured residents to further strain resources.
That annual process was put on hold during the pandemic to ensure coverage for more people in exchange for a temporary increase in federal funding. Starting in April, Wyoming health officials began removing people who no longer qualify, but a more complete picture of these “procedural removals” is expected to come out next month.
Early reports from Montana show more than 70% of those at risk of losing coverage simply didn’t provide requested information to health officials.
Wyoming’s health department started updating people’s contact details back in March, the agency stated, to make sure those who are still eligible get the renewal notice.
“Because of the pause, our clients have not received these notices by mail over the last three years,” Lee Grossman, state Medicaid agent and senior WDH administrator, said in a March press release. “We know living situations may have changed during that time for many people.”
Income has been one of the largest factors in losing eligibility so far, but thousands of Wyomingites already fall into a “gap” where they make too much to qualify for Medicaid in the state but too little to afford private insurance. To shore up this gap, 41 states have expanded Medicaid, but Wyoming lawmakers have yet to do so, often citing concerns that the federal government won’t hold up its end of the bargain to help pay for it.
The state estimates Medicaid expansion would insure about 19,000 people over two years.
To ensure they get a renewal notice, Wyoming Medicaid enrollees can update their contact information at www.wesystem.wyo.gov or by calling 1-855-294-2127.
Limited Medicaid expansion covering low-income Georgians starts July 1
By Jaymie Baxley
North Carolina is in the process of reviewing Medicaid eligibility for more than 2.9 million residents amid the unwinding of a federal mandate that prevented states from kicking people off the rolls during the COVID-19 pandemic.
Known as the continuous coverage requirement, the mandate created by Congress in early 2020 protected Medicaid beneficiaries from losing coverage even if they no longer qualified for the program. It expired in April with the end of the public health emergency, allowing states to disenroll residents for the first time in nearly three years.
Terminations are not set to begin until July in North Carolina, but a top Medicaid official for the Biden administration has noticed a concerning trend among states that are further along in the process.
He said a lot of the people losing coverage was because of “procedural red tape,” rather than being over the income limits that determine eligibility. The issue is compounded by a lack of public awareness, according to Tsai. He said many at-risk enrollees do not know about the unwinding and the effect it could have on their benefits.
“I would anticipate when terminations actually start, then you’re going to start to see a bunch of folks realizing for the first time that this is happening,” he said. “That’s of concern to all of us, and we really want to make sure that people get the word out.”
While the criteria for Medicaid varies from place to place, most states use the federal poverty level as a baseline for eligibility. This means the people at greatest risk of losing coverage should be those with incomes that now exceed the limit for their state, which in North Carolina is $24,860 in annual earnings for a family of three.
Several states are reporting worryingly high rates of terminations for what are essentially paperwork issues. A recent study by KFF, formerly known as Kaiser Family Foundation, found that more than 80 percent of unwinding-related terminations in Arkansas, Florida, Indiana and West Virginia involved residents who “did not complete the enrollment process and may or may not still be eligible for Medicaid.”
“Millions of Americans’ health insurance and health care coverage is really at risk,” Tsai said. “We are urging every state across the country to do more and to take up many of the strategies we have put out on the table from a federal standpoint that really help make it easier for eligible people to stay covered.”
One strategy the Biden administration is promoting, Tsai said, is automatically renewing coverage for people who continue to qualify for Medicaid. According to North Carolina’s unwinding plan, the state hopes to complete most renewals “without any contact with the beneficiary” using information collected from wage databases and other sources.
Still, there will be cases where the state does not have all the information needed to confirm a Medicaid recipient’s eligibility and must reach out to the person by mail. If that beneficiary fails to respond within 30 days, their coverage could be terminated.
“One of the really important messages for people is to not only update their contact information, but return the mail,” Tsai said.
Before the pandemic, Medicaid participants typically underwent annual or semiannual reviews to verify that they continued to qualify for coverage. But people who were added to the rolls while the federal mandate was in place have never gone through that process. Statewide enrollment grew 36 percent during the pandemic, with over 797,000 people newly qualifying for coverage from March 2020 until April of this year.
“What we find is a lot of people have no idea that Medicaid renewals have started,” Tsai said. “Consumers were told for three years, ‘Don’t worry, your Medicaid coverage is protected.’
“All of a sudden federal law has changed. A renewal form comes but the average consumer doesn’t know what Congress has done and doesn’t even know they need to respond to something.”
In a statement to NC Health News, the N.C. Department of Health and Human Services said 300,000 people are expected to lose coverage over the next 12 months. The agency says it is working to “ensure people eligible for Medicaid do not lose coverage and those no longer eligible are transitioned smoothly to affordable health plans.”
People ordinarily have only 60 days to enroll in a marketplace plan after losing Medicaid, but CMS has created a special enrollment period for individuals affected by the unwinding. They can apply for marketplace coverage at any time through June 31, 2024.
The timing of the unwinding presents a unique challenge for North Carolina, which is set to become the 40th state to expand access to Medicaid.
Medicaid expansion was signed into law by Gov. Roy Cooper mere days before the continuous coverage mandate expired. It is expected to benefit hundreds of thousands of North Carolinians with incomes that are less than 138 percent of the federal poverty level for their family size — $34,306 for a family of three — up from the state’s previous limit of 100 percent.
DHHS has confirmed that many residents who lose coverage during the unwinding will become eligible again once expansion officially goes into effect, likely this summer. That won’t happen until a state budget is approved, which still could be months away.
“When you start renewals with expansion still to come and you’ve got a gap, it just leads to people having a gap in coverage and some confusion and resource challenges,” Tsai said. “Hopefully folks will have every chance in North Carolina to, if they’re eligible for Medicaid expansion when that starts, be able to seamlessly transition into that.
“And of course, if they’re not eligible for Medicaid, we want to make sure they’re getting over to other forms of coverage.”