June 5th, 2023 7:00am PDT
By Hannah Recht KFF Health News
(PenniesToSave.com) – Since the expiration of pandemic protections on April 1, over 600,000 Americans have had their Medicaid coverage terminated. Analysis of state data by KFF Health News reveals that the primary reason for removal from state rolls was failure to complete required paperwork.
Typically, states conduct regular reviews of their Medicaid enrollment lists to confirm that every recipient meets the eligibility criteria. However, due to a nationwide halt in these reviews during the pandemic, individuals remained covered by the health insurance program for low-income and disabled Americans even if they no longer met the qualifications.
Currently, states are conducting a process called the Medicaid unwinding. They are carefully reviewing enrollment lists and making decisions about who will remain on the program and who will be removed. Those who no longer meet eligibility criteria or fail to complete necessary paperwork within the required timeframe will have their Medicaid coverage terminated.
The majority of people who lost their coverage in most states did not exceed Medicaid income limits, but rather due to administrative issues. Analysis from KFF Health News shows that four out of five individuals either failed to submit paperwork or omitted necessary documents, leading to their coverage being canceled. Lawmakers and advocates are now concerned about the significant number of people losing coverage and calling for a halt to the cancellation process in some states.
KFF Health News collected data from 19 states that began canceling coverage by May 1. Out of the 14 states that provided detailed numbers, either through public records or online postings, it was found that 36% of individuals who had their eligibility reviewed were disenrolled.
During the first month of the unwinding process in Indiana, approximately 53,000 residents lost their healthcare coverage. The majority of these individuals, about 89%, lost coverage due to procedural reasons such as not returning renewal forms. State Representative Ed Clere, a Republican, expressed his concern over these “staggering numbers” during a Medicaid advisory group meeting on May 24. He repeatedly questioned state officials about the issue of sending forms to outdated addresses and urged them to provide more notice than just two weeks before canceling people’s coverage.
Clere cautioned that these cancellations created an unnecessary cycle of instability. People who were removed from Medicaid will be unable to afford necessary healthcare, leading them to forgo filling prescriptions and cancel doctor visits. As a result, their chronic illnesses could worsen over time until they ultimately end up in the emergency room, where social workers will once again need to assist them in rejoining the program.
Prior to the unwinding, Medicaid or CHIP, the Children’s Health Insurance Program, provided coverage for over 93 million Americans, which represents more than 25% of the population. These programs also cover half of all children in the country, according to an analysis by KFF Health News of the latest enrollment data.
In the upcoming year, states will review participants’ eligibility in monthly groups, resulting in approximately 15 million individuals being removed from the program.
While many individuals will have access to health coverage through new employment opportunities or subsidized plans under the Affordable Care Act, there is a significant portion of the population, including children, who may become uninsured. This lack of coverage can result in individuals being unable to afford essential medications or receive preventive care. It is projected that the uninsured rate for those under 65 years old is projected to rise from its current historically low level of 8.3% to 9.3% next year, according to the Congressional Budget Office.
The percentage of enrollees decreased significantly in the initial weeks, with varying degrees across states due to their distinct approaches to the unwinding process.
States are currently conducting reviews of individuals who officials believe may no longer be eligible for insurance or haven’t utilized their insurance recently. It is expected that the high cancellation rates in those states will stabilize as agencies transition to reviewing individuals who are likely still eligible.
In Utah, almost 56% of individuals included in early evaluations were excluded. Similarly, in New Hampshire, around 44% received letters that notified them of cancellations within the first two months. These cancellations were primarily due to procedural issues, such as not returning required paperwork.
However, New Hampshire officials discovered that many individuals who did not complete the forms actually earn too much to be eligible for Medicaid, according to Henry Lipman, the state’s Medicaid director. These individuals would have been denied regardless. Nevertheless, there is still a higher number of people not returning their renewal forms than anticipated. “This indicates that we need to modify our approach,” Lipman stated.
In contrast, other states such as Virginia and Nebraska, which do not prioritize renewals based on likely eligibility, have seen a renewal rate of about 90%.
Due to a three-year hiatus in renewals, a significant number of individuals on Medicaid have never experienced or aren’t aware of the need to complete lengthy verification forms, according to a recent KFF poll. Additionally, some people moved without notifying Medicaid of their updated contact information.
Agencies required to assist enrollees who have limited English proficiency, but unfortunately, many only provide forms translated into a handful of commonly spoken languages.
As researchers have warned, tens of thousands of children are losing their healthcare coverage, even though some may still be eligible for Medicaid or CHIP (Children’s Health Insurance Program). In the first month of reviews, South Dakota ended coverage for 10% of all Medicaid and CHIP enrollees in the state, with more than half of them being children. In Arkansas, about 40% were kids.
It’s important for parents to understand that the income limits for children are actually higher than those for adults. Even if parents themselves do not qualify, they should still fill out renewal forms. Joan Alker, executive director of the Georgetown University Center for Children and Families, emphasizes the importance of this step.
In New Hampshire, the state has made the decision to prioritize the review process for families with children until later. David Lipman, the director of Medicaid in the state, expressed concerns about the possibility of a child being left uninsured. Similarly, Florida also plans to place kids with significant health conditions and other vulnerable groups at the end of their review queue.
However, Miriam Harmatz, the advocacy director and founder of the Florida Health Justice Project, has stated that state officials have sent cancellation letters to several clients with disabled children who likely still meet the qualifications. She is currently assisting these families in appealing this decision.
In the first month of the unwinding process, approximately 250,000 Floridians had their coverage revoked. The state reported to federal authorities that 82% of them lost coverage due to issues like incomplete paperwork. Responding to this concerning trend, House Democrats from Florida have petitioned Republican Gov. Ron DeSantis, urging him to pause the unwinding process.
Advocacy coalitions in Florida and Arkansas have also demanded investigations into the review process and a temporary halt on cancellations.
The Florida Department of Children and Families is making efforts to reach out to enrollees through phone calls, emails, and text messages. They are also processing late applications. However, Tori Cuddy, a spokesperson for the department, did not provide any response or clarification regarding the concerns raised in the petitions.
Federal officials are actively investigating these complaints and any other issues that arise, according to Dan Tsai, the director of the Center for Medicaid & CHIP Services. Tsai emphasized that if they discover any violations of the rules, appropriate action will be taken.
To streamline the enrollment process, his agency has directed states to automatically reenroll residents by utilizing data from other government programs, such as unemployment and food assistance. However, individuals who cannot be approved through this automated process must take prompt action.
“For the past three years, individuals were repeatedly advised to disregard the mail regarding this matter, as it was believed that the renewal would not result in termination. However, now that mail holds significance,” he remarked.
As per federal law, states are obligated to provide individuals with an explanation regarding the cause of their Medicaid coverage termination and inform them about how they can appeal this decision.
According to Harmatz, in Florida, some cancellation notices may be lacking in detail and potentially violate due process regulations. Instead of providing clear reasons for disenrollment, such as having an income that exceeds the limit or incomplete paperwork, the letters simply state that “your Medicaid for this period is ending.”
If someone chooses to request a hearing before their cancellation becomes effective, they can maintain coverage during the appeals process. Additionally, even after being disenrolled, there is still a 90-day period in which coverage can be reinstated.
In New Hampshire, 13% of individuals who were initially deemed ineligible for Medicaid have requested an extension to provide the required documentation. Lipman emphasized the importance of not wanting eligible individuals to lose their Medicaid coverage.
During the May meeting, Indiana State Representative Clere urged Medicaid officials in his state to implement immediate changes to prevent unnecessary loss of insurance coverage for individuals. In response, one official acknowledged the need for improvement and a commitment to learn from the situation.
“I’m worried that the process of learning will come at the expense of people losing their coverage,” Clere responded. “I don’t want to gain knowledge at their cost.”