Medicaid redeterminations — the process for determining if enrollees are still eligible for Medicaid coverage — are set to resume April 1 after being on hold for about three years due to the pandemic.
Up to 18 million people could lose coverage when this happens, and about 21.2% will become uninsured. Key stakeholders, including health plans, advocacy organizations and CMS, are ramping up efforts to ensure the return to redeterminations is smooth. These efforts were discussed last week at the AHIP Medicare, Medicaid, Duals and Commercial Markets Forum in Washington, D.C.
During a panel at the conference, three executives were asked what gives them comfort during this transition phase, as well as what worries them.
What reassures the executives about the return to redeterminations
Anne Marie Costello, deputy director of the Center for Medicaid and CHIP Services, said one thing that she views positively is the fact that many state Medicaid agencies have “embraced” new forms of communication to interact with their enrollees.
“I’ve never seen social media and campaigns the way that we have now for Medicaid agencies,” Costello said. “Lots of stuff was done for CHIP, but we really never advertised Medicaid and there’s been tremendous investment from states trying to get updated contact information.”
Current contact information is needed to renew Medicaid coverage.
Joan Alker, executive director and co-founder of the Center for Children and Families, agreed with Costello and added that recent Kaiser Family Foundation survey results make her feel more confident about the return to redeterminations. The survey, released last week, found that 43 states plan to take 12 to 14 months to complete renewals after the end of the continuous enrollment requirement (March 31) before returning to normal operations. By taking more time, staff will be less overwhelmed, and fewer people will be wrongly disenrolled despite still being eligible for coverage.
“It’s reassuring that a majority of states are taking the full 12 months,” Alker said. “That’s not all the states, so we got to worry that things may not go well regardless. But it’s reassuring that I think there really is a lot of good work being done.”
Arianna Muckerman, senior director of health policy at Centene Corporation, is similarly heartened that most states are taking the full year to complete redeterminations. She hopes Centene, which has the largest Medicaid footprint in the country, can help support states during this process and assist in educating Medicaid members.
What’s concerning about the looming redeterminations
Despite efforts to support those who will be disenrolled from Medicaid, one shouldn’t underestimate the “insurmountable task” ahead, said Costello of the Center for Medicaid and CHIP Services.
“[There are] 92 million people to be renewed. … It’s an unprecedented level of enrollment that we’ve never experienced,” she pointed out.
Further, states are tackling a major workforce shortage, which could place additional pressure on employees during the redetermination process, Costello added.
For Alker, the worry is surrounding how this process affects children, particularly those who may be disenrolled for procedural reasons despite still being eligible for Medicaid coverage. A procedural denial includes not responding in time to requests for information, like citizenship status.
“For children, the bigger issue is procedural denials, and that is where I worry a great deal. I think there’s a lot of confusion about that, particularly in non-expansion states. … We have the potential for hundreds of thousands of children, if not millions of children, to lose their coverage when they’re still eligible,” Alker stated.
Muckerman of Centene added that there needs to be better data from states on the reasons for disenrollment.
“We’re only getting a certain amount of data from states when it comes to usable disenrollment reasons,” she said. “Not knowing the eligibility indicators is extremely challenging. … If we are not able to understand if someone is eligible or not when they’re going through the process — we’re still doing outreach, we’re still doing education — but it limits our ability to do it in as tailored and direct of a way to help encourage exact steps that someone can take,” Muckerman said.
In an interview with MedCity News, she said that although there are challenges ahead, it’s a “common goal” for all stakeholders to keep “as many people covered as possible.”
“This is a big opportunity for us to look not just in the short term … but what are the long term improvements to enrollment and eligibility?” Muckerman said. “I think CMS and state governments are looking at what those systems, improvements are that we can make long term and this is an unprecedented opportunity to make those improvements. We’re rallying around the Medicaid population as an industry to see how we can have continuity of coverage and mitigate churn during this period.”
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