redetermination Archives – Western Center on Law & Poverty

‘Worse Than People Can Imagine’: Medicaid ‘Unwinding’ Breeds Chaos in States

November 2, 2023, By California Healthline, Phil Galewitz and Katheryn Houghton and Samantha Liss and Bernard J. Wolfson

In California, staffing shortages at county agencies that administer Medi-Cal, the state’s Medicaid program, are making it more difficult for people to renew their coverage.

In Missouri and Florida, callers waited on hold for more than two hours on hotlines to renew their Medicaid coverage.

In Tennessee, the parents of a disabled man who had been on Medicaid for three decades fought with the state this summer to keep him enrolled as he lay dying from pneumonia in a hospital.

Seven months into what was predicted to be the biggest upheaval in the 58-year history of the government health insurance program for people with low incomes and disabilities, states have reviewed the eligibility of more than 28 million people and terminated coverage for over 10 million of them. Millions more are expected to lose Medicaid in the coming months.

The unprecedented enrollment drop comes after federal protections ended this spring that had prohibited states from removing people from Medicaid during the three pandemic years. Since March 2020, enrollment in Medicaid and the related Children’s Health Insurance Program had surged by more than 22 million to reach 94 million people.

The process of reviewing all recipients’ eligibility has been anything but smooth for many Medicaid enrollees. Some are losing coverage without understanding why. Some are struggling to prove they’re still eligible. Recipients and patient advocates say Medicaid officials sent mandatory renewal forms to outdated addresses, miscalculated income levels, and offered clumsy translations of the documents. Attempting to process the cases of tens of millions of people at the same time also has exacerbated long-standing weaknesses in the bureaucratic system. Some suspect particular states have used the confusing system to discourage enrollment.

“It’s not just bad, but worse than people can imagine,” said Camille Richoux, health policy director for the nonprofit Arkansas Advocates for Children and Families. “This unwinding has not been about determining who is eligible by all possible means, but how we can kick people off by all possible means.”

To be sure, some of the Medicaid recipients who signed on to the program when the U.S. unemployment rate soared amid covid-19 lockdowns have since gotten health insurance through new jobs as unemployment dropped back to pre-pandemic lows.

And some of the disenrolled are signing up for Affordable Care Act marketplace plans. Centene CEO Sarah London, for example, told investors on Oct. 24 that the health care giant expected as many as 2.4 million of its 15 million Medicaid managed care members to lose coverage from the unwinding, but more than 1 million customers had joined its exchange plans since the same time last year.

Still, it’s anyone’s guess how many former Medicaid beneficiaries remain uninsured. States don’t track what happens to everyone after they’re disenrolled. And the final tallies likely won’t be known until 2025, after the unwinding finishes by next summer and federal officials survey Americans’ insurance status.

DHCS official discusses Medi-Cal unwinding data

August 9, 2023, By Hannah Saunders, State of Reform

California began redetermining Medi-Cal eligibility of members in April, and has since disenrolled 225,231 individuals, while 499,093 individuals have maintained their Medi-Cal coverage, according to Yingjia Huang, assistant deputy director of Health Care Benefits and Eligibility at the Department of Health Care Services (DHCS).

This week, Huang hosted a webinar with stakeholders to go over Medi-Cal unwinding information, and shared the state’s interactive dashboard to explain June data.

The diversity and volume of individuals in California make Medi-Cal redeterminations an extraordinary task for all involved, Huang said, adding that over 15 million Californians will undergo the process. DHCS began preparing for the unwinding several years ago when the federal public health emergency was put in place because they were unsure of when the emergency order would end.

The data on DHCS’s dashboard helps the department develop strategies and investments for supporting the Medi-Cal population, and helps the department decide whether it needs to alter messaging to members.

“This is the first time the department has ever posted something so early, which is 45 days after the actual last day of the coverage month of June,” Huang said, adding that DHCS usually reports data 90 days after June, or in October. “This is in the spirit of full transparency in the unwinding journey.”

Total Medi-Cal enrollment for June was 15,568,357 individuals statewide, with the first set of disenrollments taking place on July 1st. While the state continues to conduct redeterminations, individuals are continuing to sign up for coverage. In June, DHCS received 143,069 applications in total, 125,145 of which were determined to be eligible for Medi-Cal coverage or the Children’s Health Insurance Program.

225,000 Medi-Cal enrollees lost coverage in June; here’s how that compares with prior years

July 21, 2023July 25, 2023, By Cathie Anderson, Sacramento Bee

A three-year hiatus ended in June for more than 1 million California Medi-Cal enrollees. They once again had to prove they were eligible for the government-funded health care coverage, and roughly eight out of 10 got their paperwork in by the June 30 deadline, California Medicaid Director Jacey Cooper said Thursday.

That was about the same proportion of enrollees who successfully completed monthly re-enrollment in California before Congress enacted the Families First Coronavirus Response Act in the early days of the COVID-19 pandemic, requiring states to continue covering anyone who was approved for Medi-Cal or any other Medicaid program around the country.

Beginning in June and continuing through May of next year, Medi-Cal enrollees have to re-apply for coverage by the end of the month in which their eligibility dates fall.

Medi-Cal discontinued coverage for about 225,000 individuals, or roughly 21% of people whose coverage came up for renewal in June, Cooper said, but those who lost coverage have 90 days to provide the necessary documentation and restore their coverage retroactive to the cut-off date.

More than 220K people kicked off Medi-Cal in its first checkup since COVID

July 21, 2023July 25, 2023, By Ana Ibarra, CalMatters

About 225,0000 Californians lost their free or low-cost health coverage as of July 1, in the first round a Medi-Cal renewal process that had been suspended since early in the COVID-19 pandemic.

That’s approximately 21% of the over 1 million people who were due to reapply for coverage in June, according to preliminary numbers released by state health officials on Thursday.

Medi-Cal, the state’s health insurance program for low-income people, typically reviews enrollees’ eligibility every year. The state paused that process during the pandemic at the orders of the federal government, but resumed in the spring.

Less than 3% of the people who lost coverage no longer qualify for Medi-Cal because their household income now exceeds the program’s limits.

That means the majority of people were kicked off because they didn’t return a renewal packet and county Medi-Cal offices couldn’t verify an enrollee’s income. Cooper said the counties and state are trying to reach enrollees in multiple ways — email, mail and texts.

David Kane, a senior attorney with the Western Center on Law and Poverty, said it is concerning that tens of thousands of people could be without insurance even though they are eligible. They may have failed to respond for a number of reasons, such as not receiving the packet or not getting the packet in their language.

“I don’t think today’s preliminary numbers mean we can all sit back and think things are OK,” Kane said. “These disenrollments are not inevitable. The state, counties, advocates, and community groups together have the power to help more people keep their Medi-Cal.”

Over 34,000 L.A. County households lost Medi-Cal in July amid rollback of COVID rules

July 20, 2023July 25, 2023, By Emily Alpert Reyes, Los Angeles Times

More than 34,000 households in Los Angeles County have had their Medi-Cal coverage discontinued this month as California joins other states in beginning to cut off people from Medicaid programs who no longer meet income requirements or whose paperwork was not submitted in time.

The latest numbers were shared by L.A. County officials at a public meeting Wednesday. Health officials and legal advocates are closely eyeing such early figures to see how a major shift in health coverage is playing out in L.A. County and across California, amid concerns that people who legally qualify for Medicaid could end up losing it unnecessarily or suffering interruptions in their coverage.

Earlier in the pandemic, federal rules had allowed people to hang on to Medicaid coverage without turning in annual paperwork to prove they were still eligible. Now states have started ejecting people from their programs again after the federal government rolled back those pandemic rules.

Tens of thousands of L.A. County residents could soon lose Medi-Cal coverage. Here’s why

July 3, 2023July 25, 2023, By Emily Alpert Reyes, Los Angeles Times

Tens of thousands of people in Los Angeles County could lose their Medi-Cal coverage in July, according to preliminary data provided to a health plan that serves Angelenos on the public program.

L.A. Care, a publicly operated health plan in L.A. County, said that early data provided by the state indicate that roughly 40,000 of its members enrolled in Medi-Cal could lose their coverage this month, although final numbers are still pending.

Those figures do not include Medi-Cal recipients who are not covered by L.A. Care, which serves roughly 2.7 million of the nearly 4.7 million people in L.A. County who were enrolled in Medi-Cal as of this spring, according to state figures. The numbers are expected to keep shifting as more people return paperwork that was due Friday to renew their coverage in California’s Medicaid program, the beginning of a process that will play out over the next year.

But the tentative figures are an early sign of the serious shift underway as the federal government has rolled back rules that helped people stay on Medicaid, one that has troubled health providers and advocates who fear many patients will unnecessarily lose medical coverage for which they qualify.

“Losing Medi-Cal coverage is not a mere inconvenience or annoyance,” said David Kane, an attorney at the Western Center on Law & Poverty. “For far too many it can be life-threatening. It can mean that transportation to dialysis does not show up. Surgery is canceled. You cannot pick up your prescription drugs.”

Medi-Cal Enrollees: Here’s How to Verify Your Eligibility

May 5, 2023May 8, 2023, By Bernard J. Wolfson, California Healthline

Medi-Cal, the state’s version of the Medicaid health insurance program for low-income residents, has embarked on a 14-month effort to reexamine the eligibility of its nearly 15.8 million members. It is part of the massive “unwinding” being undertaken by all state Medicaid programs after three pandemic years during which their rolls swelled. States had agreed, in exchange for extra funding from the feds, not to boot anyone except in cases such as fraud, death, or a move out of state.

On April 1, Medicaid restarted the annual eligibility checks that had been the norm before the pandemic. It will be the biggest shake-up in U.S. health coverage since the Affordable Care Act, though it cuts the opposite way: Between 8 million and 24 million people will likely be bounced from Medicaid nationally, including an estimated 2 million to 3 million in California.

To minimize the number of enrollees dropped unnecessarily, California’s Department of Health Care Services, which runs Medi-Cal, has launched a $25 million advertising and outreach campaign that will send messages in 19 languages. The department is enlisting the assistance of nearly everyone who has contact with Medi-Cal enrollees: county offices, health plans, medical providers, advocacy groups, and volunteers. And it got $146 million in supplemental funding to help counties cope with the unprecedented number of renewal decisions.

‘A perfect storm’: Patients trying to hang on to Medi-Cal face long waits for help

April 25, 2023July 25, 2023, By Emily Alpert Reyes, Los Angeles Times

Canned music droned from the telephone as Jessica Sanchez waited, fidgeting and shifting her pregnant belly in her chair at the Santa Monica community health center.

It had been an hour since Sanchez and a Venice Family Clinic worker had dialed up a Los Angeles County agency for help. At a prenatal appointment, Sanchez, 33, had abruptly discovered that her health coverage had been cut off months earlier. The news rattled Sanchez, who was already in her third trimester.

‘A disaster waiting to happen’: Do staff shortages threaten Medi-Cal plans for renewing recipients

April 19, 2023July 25, 2023, By Cathie Anderson, Sacramento Bee,

In one report after another earlier this year, counties from Los Angeles to Sacramento warned Medi-Cal officials that they don’t have enough trained staff — or simply don’t know whether they do — to process the millions of Californians whose cases come up for renewal starting in June.

For three years now, ever since federal officials declared a public health emergency in March 2020, U.S. law has prohibited Medi-Cal from kicking millions of Californians off its rolls, even if their incomes pushed past eligibility limits.

The end of so-called continuous coverage will come over a rolling 12-month period, based on the last date when a Medi-Cal enrollee’s eligibility was determined. If enrollees don’t submit the proper documentation by time their eligibility month ends, they will lose their benefits.

State officials estimate that 2 million to 3 million Medi-Cal enrollees could lose coverage because counties can’t manage the volume of cases or they don’t have the right addresses for enrollees or they can’t get critical information in time.

Millions of Children on Medicaid at Risk of Losing Coverage

March 28, 2023March 28, 2023, By Ganny Belloni, Bloomberg Law,

More than 6.7 million children are at risk of losing insurance coverage once pandemic-era restrictions on Medicaid income eligibility checks are lifted on April 1, according to a report by the Georgetown Center for Children and Families.

Legislation enacted early in the pandemic in 2020 temporarily increased federal funding for state Medicaid programs under the condition that states continuously cover beneficiaries until the end of the public health emergency. The ranks of Medicaid beneficiaries grew by nearly 20 million people as the program acted as a health insurance safety net. However, the Consolidated Appropriations Act of 2023 slowly unwinds the federal continuous coverage requirement through May 2024, allowing states to start eligibility redeterminations next month for all 83.5 million Medicaid beneficiaries—including more than 34.2 million children.

To protect children in low-income families, the Consolidated Appropriations Act requires states to provide 12 months of continuous Medicaid and Children’s Health Insurance Program eligibility to children under 19 beginning Jan. 1, 2024, if they don’t already do so. Most states have some form of continuous eligibility for children to protect them from losing coverage during redeterminations of their parents’ eligibility, but 17 states and the District of Columbia do not have such a provision, the Georgetown center found.

Redeterminations require beneficiaries to reapply for health insurance, verifying their income and ensuring that they meet all the other eligibility criteria to continue to receive benefits. However, the process can be complicated and take up to 14 months, and families who fail to complete it on time may lose coverage.

The impact of redeterminations on children’s health-care access concerns many Medicaid stakeholders across the country. Eligibility checks have traditionally caused coverage losses due to bureaucratic roadblocks, said Jennifer Wagner, director of Medicaid eligibility and enrollment at the Center on Budget and Policy Priorities, a nonpartisan research and policy institute.

“Historically, we lose a lot of people during the renewal. Recipients are often sent a form by mail to the last known address, which may have changed. Some people might not get the notice they got a renewal in the mail. Others might not act timely because they have very complex situations and may not respond in time. Some might not even understand the notices that they are getting. They’re historically very confusing,” she said.

Public policy advocates also fear that chronic staffing shortages will cause state Medicaid agencies to face backlogs in processing redetermination applications, leading to more unintended policy cancellations.

A survey by the National Association of Medicaid Directors found that over a fifth of all state Medicaid agencies have job vacancy rates of over 20%, with some states seeing up to 40%.

The problem is nationwide, even in well-funded states like California, which invested $146 million into its unwinding strategy, stakeholders say. California has done little to rectify the chronic shortages in front-line Medicaid workers in its 58 counties, David Kane, senior attorney at the Western Center of Law & Poverty, said.

Tag: redetermination