MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: States incorrectly processing child eligibility and the household level using automated systems are now being “required” by CMS to slow down.

 
 

 
 

Clipped from: https://www.healthcaredive.com/news/cms-pauses-medicaid-redeterminations-30-states/694485/

An article from

 
 

Nearly 500,000 people will regain Medicaid or Children’s Health Insurance Program coverage after being improperly removed from the rolls during redeterminations, according to the HHS.

 
 

Kameleon007 via Getty Images

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Dive Brief:

• Federal regulators ordered 30 states to pause procedural disenrollments of Medicaid beneficiaries after warning about inappropriately removing children and other enrollees from coverage during the ongoing redeterminations process. 
  
• Last month, the CMS sent a letter to all states, Washington, D.C., Puerto Rico and the U.S. Virgin Islands about a systems issue with automatic renewals. Some states were conducting eligibility checks at the family level, even though some members of the household — like children — face a lower bar to remain covered under the safety-program.
  
• Nearly half a million people will regain Medicaid or Children’s Health Insurance Program coverage due to the fix, according to a release from HHS. 
  

Dive Insight: 

More than seven million Medicaid beneficiaries have been disenrolled from the program geared toward low-income people since the redeterminations process began this spring, according to health policy research firm KFF.

States are required to figure out which enrollees are still eligible for the safety-net program after a long period of continuous enrollment during the COVID-19 pandemic, where beneficiaries were kept enrolled in Medicaid to avoid coverage losses during a public health emergency. 

But patient advocates have raised concerns about the large number of procedural disenrollments, or cuts due to administrative reasons like not completing paperwork. 

Among states with available data, 73% were removed from coverage due to procedural reasons, according to KFF. 

In 16 states reporting age breakouts, children accounted for 42% of Medicaid disenrollments. 

The federal government has taken steps to cut down on the number of inappropriate disenrollments including offering states more flexibility and pausing coverage terminations in states that weren’t compliant with renewal requirements.

“I think unwinding has revealed that there have always been more procedural terminations than we realized. And that’s contributed to the historic patterns of churn on and off of Medicaid that have impacted people’s ability to keep their coverage,” said Allison Orris, senior fellow at the Center on Budget and Policy Priorities, during a meeting of the Medicaid and CHIP Payment and Access Commission Thursday. 

Automatic renewals, or ex parte renewals, use existing data to determine whether beneficiaries are still eligible for coverage, and are key tools to keep people enrolled with lower documentation burden, regulators said. 

But some states were enacting renewals of whole households at once, even though some members may have different eligibility requirements, the CMS said in a letter last month.

Alaska, Colorado, Connecticut, Delaware, Washington, D.C., Georgia, Hawaii, Idaho, Illinois, Iowa, Kansas, Kentucky, Maine, Maryland, Massachusetts, Minnesota, Nebraska, Nevada, New Jersey, New Mexico, New York, North Dakota, Ohio, Oregon, Pennsylvania, Vermont, Virginia, West Virginia, Wisconsin and Wyoming were not auto-renewing at the individual level, according to preliminary data released Thursday.

ennsylvania and Nevada estimated the error affected more than 100,000 people in their states. Other states reported lower numbers or were still assessing the impact.

Dan Tsai, deputy administrator and director of the Center for Medicaid and CHIP Services, said Thursday there’s “no doubt” the Medicaid program will come out of the redeterminations process stronger due to the increased focus on eligibility and outreach.

“I hope this will lead to a renaissance over the next multi-year period of how we in the country collectively think about eligibility and the ease of maintaining and getting access to coverage through Medicaid and other programs,” he said during the MACPAC meeting. 

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: And so it begins.

 
 

 
 

Clipped from: https://www.cnn.com/2023/08/22/politics/florida-medicaid-eligibility-lawsuit/index.html

CNN  — 

Two consumer advocacy groups filed a lawsuit in a Florida federal court Tuesday seeking to halt the state’s termination of residents’ Medicaid benefits.

The suit is the first in the nation to challenge states’ resumption of reviewing Medicaid enrollees’ eligibility and dropping those deemed no longer qualified. The process, which Congress had suspended for three years during the Covid-19 pandemic, restarted as early as April, depending on the state.

The Florida Health Justice Project and the National Health Law Program filed the lawsuit on behalf of three Floridians in US District Court in Jacksonville against the state’s Agency for Health Care Administration and the Department of Children and Families. The residents are a 25-year-old woman and her 2-year-old daughter, who has cystic fibrosis, as well as a 1-year-old girl.

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The plaintiffs argue that the notices the agencies are sending to inform enrollees that they are no longer eligible are confusing and don’t provide sufficient explanation as to why they are losing coverage.

“As a result, Plaintiffs and class members are losing Medicaid coverage without meaningful and adequate notice, leaving them unable to understand the agency’s decision, properly decide whether and how to contest their loss of Medicaid coverage, or plan for a smooth transition of coverage that minimizes disruptions in necessary care,” the complaint reads. “Without Medicaid coverage, Plaintiffs are unable to obtain care they need, including prescription drugs, children’s vaccinations, and post-partum care.”

The advocates are asking the court to require the state to stop terminating enrollees until the agencies provide adequate notice and an opportunity for a pre-termination fair hearing.

Mallory McManus, deputy chief of staff for the Department of Children and Families, called the lawsuit “baseless.” While she said the state cannot comment on pending litigation, she said the letters to recipients are “legally sufficient.”

The federal Centers for Medicare and Medicaid Services “approved the Department’s redetermination plan based on their regulations. There are multiple steps in the eligibility determination process and the final letter is just one of multiple communications from the Department,” said McManus, adding that the agency “continues to lead on Medicaid determinations and being fiscally responsible.”

The Agency for Health Care Administration did not immediately return a request for comment.

Nearly 183,000 Floridians have been issued notices saying they no longer qualify for Medicaid, according to the lawsuit. Hundreds of thousands more will have their coverage reviewed in the coming year.

In addition to those determined ineligible, nearly 226,000 were dropped for so-called procedural reasons, typically because enrollees did not complete the renewal application, according to KFF, formerly the Kaiser Family Foundation. This often happens because it may have been sent to an old address, it was difficult to understand or it wasn’t returned by the deadline.

Nearly 898,000 Florida residents have had their coverage renewed, according to KFF.

Nationwide, more than 5.2 million people have been disenrolled since the so-called Medicaid unwinding began in the spring, according to KFF. Nearly three-quarters of those who have lost coverage were dropped for procedural reasons.

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: Prediction- there will be 10 lawsuits by Labor Day, and the next one will come out of AR. May be able to predict which law firm within a week depending on patterns we see in the next few.

 
 

 
 

Clipped from: https://arkansasadvocate.com/2023/08/22/arkansas-medicaid-recipients-share-concerns-with-federal-and-state-officials/

Protesters want the state to pause its ongoing disenrollment of Medicaid recipients whose eligibility paperwork hasn’t been received

 
 

Protesters march from Woodlane Street to the Arkansas Capitol on Tuesday, Aug. 22, 2023, to deliver a letter to Gov. Sarah Huckabee Sanders’ office detailing the difficulties they have had with the state’s Medicaid program. (Tess Vrbin/Arkansas Advocate)

A group of Arkansans on Tuesday petitioned state and federal officials to intervene in the state’s administration of Medicaid, which they have repeatedly said needs improvement.

Arkansas Community Organizations held the latest of several protests this year airing Medicaid recipients’ complaints, including difficulties ensuring that the state Department of Human Services has accurately recorded or updated people’s income and contact information.

The organizers wrote a letter to the federal Centers for Medicare and Medicaid Services, asking its division that administers Medicaid and the Children’s Health Insurance Program (CHIP) to work with Arkansas officials on improving the state’s administration of benefits.

Medicaid is a joint federal and state health care program for people with disabilities and those who meet certain income thresholds. The program covers about 90 million Americans, including more than 900,000 Arkansans.

The letter to CMS lists changes to Medicaid that recipients have repeatedly said would make services more accessible to them and others.

Examples include using plain language in written notices that DHS sends to Medicaid clients and staffing DHS’ county offices with employees who fully understand the rules and criteria of Medicaid’s many programs.

The protesters met outside the Victory Building across the street from the state Capitol building, carrying signs that said “Educate your employees” and “Try harder to reach everyone,” among other things.

Rally co-organizer Joyce Means said she is eligible for Medicaid coverage under the federal Pickle Amendment of 1977. The amendment created a class of Medicaid eligibility for people who receive Social Security benefits but exceed the income limit for Supplemental Security Income, which is aimed at people with disabilities and low-income older adults.

“Tell me why I had to go to DHS to explain to them what the Pickle Amendment is,” Means said. “I had a worker tell me he’s worked there for over four years and this was his first time hearing of this.”

Additionally, some adults in Arkansas who receive Medicare coverage due to their older age have been receiving smaller Social Security checks lately, Means said.

“Medicaid pays the premiums for Medicare, so when that happens, it comes out of the recipient’s [Social Security] check, and some people are already low-income or on disability,” Means said.

Post-pandemic unwinding

Organizers’ letter to CMS also requests that Arkansas pause its ongoing project of disenrolling Medicaid recipients whose coverage was extended by the federal government during the COVID-19 pandemic. The extension ended in May, and states began “unwinding” it in April.

Since then, DHS has disenrolled more than 144,000 Arkansans from Medicaid after not receiving required eligibility information, in addition to the clients who asked to be disenrolled or made too much money to be eligible.

Arkansas Community Organizations have repeatedly expressed concern that some Arkansans who are still eligible for Medicaid could lose their coverage or have already lost it due to bureaucratic hurdles.

Most states have a full year to conduct the “unwinding,” but Arkansas has six months, as required by a 2021 state law. Arkansas Medicaid recipients asked in March for a one-year grace period, to no avail.

The group protesting Tuesday delivered the letter to the offices of Arkansas’ two U.S. Senators, John Boozman and Tom Cotton, in the Victory Building and then to Gov. Sarah Huckabee Sanders’ office in the Capitol.

Sanders’ and Boozman’s staff accepted the letter; no one answered the door at Cotton’s office.

Jennifer Cole said she believed Boozman’s staff listened to her and the other protesters.

“I don’t know that we’re going to get the senator’s ear, but we can hope,” she said.

Cole said she lost access to the Supplemental Nutrition Assistance Program, commonly known as food stamps, for six months due to paperwork issues at DHS.

“I called them and they had received [my paperwork], but nobody had had a chance to look at it, and that falls back on us,” she said.

Children have made up more than 40% of Arkansas Medicaid enrollees since July 1, according to DHS data.

Nearly 40% of the state’s disenrolled Medicaid clients in April and May were children, according to data collected by health policy researcher KFF, which has been tracking the Medicaid unwinding process nationwide.

Sholanda Woods said her daughter is one of them.

“[Sanders] came into office talking about how she loves our babies and our kids and stuff,” said Woods, a single parent. “…My child has diabetes and I can’t go to the pharmacy and get her medicine or anything like that.”

Spokespeople for Boozman and Cotton did not respond when asked via email whether the officials had seen the protesters’ letter as of Tuesday afternoon.

Alexa Henning, a spokeswoman for Sanders, said in an email that Arkansas has been following state and federal law throughout the unwinding process.

“DHS is using every tool to ensure people who are eligible remain covered and working with those who are no longer eligible to get coverage through their job or the healthcare marketplace,” Henning said.

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: About 90k Texans are getting their Medicaid cards back. Best I can tell they were terminated due to errors in the TX IT system.

 
 

 
 

Clipped from: https://news.bloomberglaw.com/health-law-and-business/hhs-moves-to-pause-medicaid-coverage-terminations-in-texas

The Biden administration is working with Texas to restore tens of thousands of people to the state’s Medicaid rolls who had lost coverage erroneously, a senior CMS official said Tuesday.

The Centers for Medicare & Medicaid Services worked with the state’s Medicaid agency to reinstate coverage for those individuals back to the date when their coverage was terminated, the official, who spoke on the condition of anonymity, told Bloomberg Law. The CMS didn’t require the state to pause terminations, the official said.

Roughly 90,000 individuals are expected to regain coverage by the end of this month, said another senior CMS official, who also spoke on the condition of anonymity. Most already have, that official said.

The officials’ remarks follow a letter from Democratic House members from Texas who urged the CMS to investigate reports of problems at the Texas Medicaid agency.

The lawmakers pointed to a whistleblower letter in which anonymous employees at the Texas Health and Human Services Commission alleged system failures leading to erroneous coverage terminations and burdensome manual reinstatements.

The whistleblower letter claimed approximately 80,000 individuals have already lost Medicaid coverage incorrectly, including thousands of pregnant women and seniors. Employees allege they were forced into overtime to process 6 million beneficiaries in eight months, contrary to federal guidance.

The Texas Democrats urged the CMS to intervene, alleging Texas is not complying with federal Medicaid requirements.

The Texas Department of Health and Human Services didn’t immediately respond to a request for comment.

The news comes after nearly 600,000 Texans have already lost Medicaid coverage in recent months, with most citing loss due to procedural rather than eligibility reasons. Medicaid eligibility checks had been paused during the Covid-19 pandemic, but have resumed in recent months.

The legislators warn another round of “catastrophic coverage losses” once Texas begins sending renewal notices next month to a third cohort of children, seniors, and disabled enrollees.

Rep. Lloyd Doggett, one of the Texas Democrats who signed the letter, said in a statement to Bloomberg Law that “CMS has the statutory authority and duty to intervene in this immediate health care crisis.”

He said he was “urging swift federal action to pause Medicaid redeterminations in Texas until a complete investigation and corrective action are undertaken to prevent catastrophic interruption of care for many disadvantaged families.”

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: There might be a little bit of bias in how the media is reporting on the return to normal operations.

 
 

Clipped from:

https://www.usatoday.com/story/opinion/2023/08/11/medicaid-cuts-ineligible-enrollees-protect-taxpayers/70560500007/

 
 

Perhaps you’ve heard: Republican states are heartless. 

Such is the media narrative on Medicaid as states begin the long-overdue process of removing millions of now ineligible recipients who signed up for the program during the pandemic. The real story is that Republican states are defending taxpayers and the truly vulnerable, while reversing the country’s march toward socialized health care.

Get a few paragraphs into news stories about reductions in the number of people receiving Medicaid, and the villain and victim become clear: Republicans and the less fortunate, respectively.

Yet, this caricature bears no resemblance to reality. Republican-led states are leading the effort to disenroll about 20 million Americans who were ineligible for Medicaid yet couldn’t be removed due to federal mandates during the pandemic.

Pandemic led to huge expansion of the welfare state

That restriction led to one of the biggest welfare expansions in American history, pushing the number of people on Medicaid to more than 100 million for the first time while costing taxpayers at least $16 billion a month.

Despite the Biden administration’s efforts to extend the mandate, the Medicaid expansion expired April 1.

 
 

States report having removed at least 4.1 million individuals since then. Texas and Florida have done the most work, right-sizing Medicaid by a combined 900,000 people. Arkansas has removed at least 300,000 people out of an estimated 422,000 who are potentially ineligible, the fastest pace in the nation.

These states are rushing to restore Medicaid to its intended purpose, save taxpayers billions of dollars and preserve resources for the truly needy.

The news media give the impression that ineligible Medicaid recipients are especially vulnerable, but in fact, they generally are ineligible because they make too much money. Many signed up after temporarily losing jobs during pandemic-related shutdowns, but states were unable to remove them for more than three years, even as the economy bounced back and they returned to work.

Biden Medicaid cuts will hurt millions.Democrats need to stop him.

Good options are available for people not eligible for Medicaid

A majority of removed Medicaid enrollees have access to employer-sponsored coverage, federal subsidies on the insurance exchange or other affordable coverage options.

Much of the news coverage focuses on the “procedural reasons” that states are using to remove people from Medicaid rolls. That explanation accounts for about 75% of those who lose Medicaid benefits. The phrase gives the impression that people are kicked off Medicaid on technicalities. In fact, it means enrollees did not establish their eligibility for the program.

Many might have failed to comply with state requests for information because they knew they were ineligible or already had other coverage.

‘Bidenomics’ in action:Democrats’ excessive spending, mounting debt earn US credit downgrade

Some states do deserve criticism. California and New York have removed about 385,000 people from Medicaid, but with up to 2.8 million ineligible enrollees in California and more than 1 million in New York , they’re clearly slow-walking the process.

Blue states are likely waiting for the Biden administration to roll out a new rule that will keep Medicaid broken indefinitely. Last year, the Centers for Medicare and Medicaid Services proposed a mandate that would block states from using commonly used practices to discover ineligible Medicaid recipients.

The transparent goal is to keep them on Medicaid, further eroding the private market and paving the way to socialized health care. The regulation could be made final later this year or early next, before states finish right-sizing Medicaid.

The contempt for taxpayers and the truly vulnerable is astounding. Medicaid is already consuming a bigger and bigger share of state budgets, leaving less funding for critical needs such as public safety and education. Yet, blue states and the Biden administration are content to let this crisis continue. 

 
 

This is the essence of socialized health care: Subsidizing subpar coverage for people who can get other health insurance, while leaving less money for the vulnerable people who need Medicaid. The news media is right that someone is heartless, but the culprits aren’t in Republican-led states.

Jonathan Ingram is vice president of policy and research at the Foundation for Government Accountability.

 
 

From <https://www.usatoday.com/story/opinion/2023/08/11/medicaid-cuts-ineligible-enrollees-protect-taxpayers/70560500007/>

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: More on the CMS effort to get faster states to slow down their RTNO. Including links to the letters they sent August 9 to all 50 states.

 
 

 
 

Clipped from: https://www.politico.com/news/2023/08/10/biden-administration-states-medicaid-00110686

More than 4 million people have had their Medicaid benefits terminated in the last four months, including nearly three-quarters who have lost coverage because of paperwork problems.

 
 

The criteria don’t reflect all potential challenges with states’ unwinding processes, the letters are only based on data reported by states in May and some states are missing data.

Still, CMS’ decision to make the letters available online represents a sharp about-face for an agency that has refused for months to single out any state it believes may be violating federal law — or even name specific criteria that would trigger stronger action against states — for fear of damaging its relationships with them.

“It looks like this is certainly part of the paper trail to move to more explicit and hopefully rigorous enforcement activities,” said Joan Alker, executive director and co-founder of Georgetown University’s Center for Children and Families. “It’s a positive sign that CMS is becoming more transparent about their enforcement activities.”

It also comes as the agency faces increasing pressure both from Congress and state-level advocates who are alarmed by the high rates of coverage losses and have called on the agency to take more forceful action for noncompliant states, like yanking federal funding.

More than 4 million people have had their Medicaid benefits terminated in the last four months, including nearly three-quarters who have lost coverage because of paperwork problems.

More than half of states were flagged by CMS as having high rates of people who lost their Medicaid benefits for procedural reasons, meaning the state was unable to make a determination about whether the person was or was not eligible for coverage.

CMS said the data indicate people may not be receiving renewal notices, are unable to understand them or are running into challenges submitting renewal forms — in short, eligible people may be losing coverage. The agency noted that federal regulations require it to continue to provide Medicaid to eligible individuals until they are found ineligible.

Sixteen states were flagged for having long call center wait times and high call abandonment rates, which CMS said are “impeding equitable access” to Medicaid coverage and may indicate potential noncompliance with federal requirements under the Social Security Act.

Sixteen states were also singled out because a large number of Medicaid applications based on income were not processed within the 45-day window required by regulation.

Jim Beardsworth, a spokesperson for Rhode Island’s Department of Human Services, said the state has a “rigorous quality control program” to review procedural terminations and has delayed ending coverage for families and children until the beginning of 2024.

He added that the state has plans to soon increase its call center support through a cross-agency partnership, and is working with federal officials to build additional capacity, and that the state had reduced its application processing times to meet federal guidelines as of Aug. 1.

The four other states flagged for all three criteria did not respond to requests for comment on Thursday, nor did CMS.

While much attention has been paid to Republican-led states that have prioritized removing ineligible people from their Medicaid rolls as quickly as possible and have, as a result, seen high rates of coverage losses, the letters suggest significant problems in blue states, which are by and large taking their time with the unwinding process.

New Mexico and Rhode Island, two of the states flagged for all three criteria, are run by Democrats. And four more blue states were identified as falling short on two of the criteria.

“They need to apply these criteria across the board, and they’re doing that, and that’s good,” Alker said.

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: Somebody finally realized what the PHE means for Maximus.

 
 

 
 

Clipped from: https://jacobin.com/2023/07/medicaid-enrollment-maximus-contractor-profits

As more than 17 million people stand to lose health insurance in the unfolding Medicaid eligibility review disaster, a little-known company called Maximus is set to make massive profits off of helping the government deny people health insurance.

 
 

Dr Candice Jones attends to her patients Nihmaya Farrell, six, center, and Nichaya Simmons, thirteen, left, and mother Natasha James at the Edgewater Pediatrics in Orlando, Florida, on January 14, 2021. (Willie J. Allen Jr / Orlando Sentinel / Tribune News Service via Getty Images)

Celebrate Bastille Day with Jacobin. Get or give a print subscription for just $7.89 this weekend by following this link.

As more than seventeen million people stand to lose health insurance in the unfolding Medicaid eligibility review disaster, there’s one company licking its lips: Maximus, a little-known federal contractor that is one of the biggest players in privatizing essential government services previously done by civil servants — in particular, taking over states’ capacity to determine who is eligible for Medicaid and who isn’t.

In a February earnings call for shareholders and Wall Street analysts, Maximus’s CEO Bruce Caswell announced that the current nationwide eligibility review of ninety million people on Medicaid and other government health insurance programs “is unprecedented in its scope,” and will allow Maximus “to gain traction in the market.” As a result of the deluge in Medicaid “redeterminations,” Caswell said, “we expect improvement to operating margin.”

The company has accordingly boosted its earnings estimate by $100 million. Maximus’s share price is closing on its all-time high, up nearly 50 percent since October. Caswell earned $6.3 million in 2022.

Outsourcing Medicaid eligibility reviews to Maximus has major implications beyond the company’s expanding bottom line. It also removes essential government services from the realm of public accountability, while draining resources from governments.

“One of the big concerns here is it’s a company that’s really making money coming and going from the county, state, and federal governments,” said Daniel Hatcher, a law professor at the University of Baltimore who has studied Maximus. “People who are benefiting the most are the company, occasionally governments, but not the people who are supposed to be benefiting from Medicaid services.”

Along with draining public finances, Maximus and other Medicaid redetermination contractors are incentivized to advocate for making Medicaid even more of a bureaucratic nightmare for recipients.

“If you look at the payment structure of these contracts, the more red tape, the more money Maximus makes,” Hatcher said. “The harder it is to get enrolled, the easier to get kicked off — the more money Maximus and contractors are making.”

Maximizing Profits

During the COVID-19 pandemic, lawmakers required states to stop removing people from Medicaid, the national health insurance program for low-income Americans. The move led to record enrollment in a strictly means-tested program designed to benefit only the very poor — one from which people are often arbitrarily removed.

Late last year, Congress passed and President Joe Biden signed a year-end spending bill directing states to resume annual redeterminations of Medicaid recipients’ eligibility for the program. Now, an estimated seventeen million people, and potentially up to twenty-four million, could lose their coverage.

Studies suggest that expanding Medicaid coverage substantially reduces deaths, and positively impacts people in poverty throughout their entire lives.

While there are significant reporting gaps as to where Maximus is doing redeterminations and how states are reporting eligibility reviews, Maximus dominates 60 percent of the Medicaid eligibility market, according to a recent report in Modern Healthcare.

While the final determinations for Medicaid eligibility must be completed by public employees, every other step of the process — from processing applications, to running call centers, to reaching out to people on the verge of losing benefits — can be done by private contractors.

In a recent investor presentation, Maximus wrote that it was boosting its “revenue and earnings guidance to account for Medicaid redeterminations,” and noted that “actual volume flow and beneficiary interaction will influence overall profitability.”

So far, more than 70 percent of those who have recently lost Medicaid coverage have been terminated for administrative reasons, such as not responding to a piece of mail or getting dropped from a call with a redetermination specialist, rather than because they were deemed ineligible due to their income and assets. Many of these people are likely still technically eligible for the program.

Maximus runs the call center for Medicaid eligibility in Indiana, where 85 percent of the 107,000 people kicked off Medicaid this year lost coverage because of procedural reasons. According to Maximus’s $400-million Indiana contract, up to seven percent of its eligibility calls in the state in a given week can be dropped before the company is penalized.

“We do not make Medicaid eligibility determinations,” Maximus said in a statement to the Lever:

Our job is to support the states’ responsibilities to ensure that everyone who is eligible for Medicaid remains covered. If they are no longer eligible for Medicaid, we work with the states to refer them to other health care options such as the insurance marketplace. We are not paid in any state on the basis of whether an individual is found eligible or ineligible.

Maximus did not answer follow-up questions about the scope of its work in various states and how much revenue the company expects to generate from its Medicaid redetermination business.

As Maximus seeks to expand its Medicaid redetermination work, the company has leaned into lobbying and political donations.

Maximus has donated $2.5 million to national political groups affiliated with state and local politicians since 2017. That includes $955,000 to the Republican Governors Association; $665,000 to the Democratic Governors Association; $450,000 to the Republican State Leadership Committee, which funnels money to GOP state legislative campaigns; $210,000 to the Republican Attorneys General Association; and $165,000 to the Democratic Attorneys General Association.

The company additionally donates to the National Governors Association, a nonpartisan group that represents governors from both parties.

Maximus spent $960,000 on federal lobbying alone in 2022, and its roster of lobbyists included former longtime representative Al Wynn (D-MD), who is now a senior director at the lobbying powerhouse Greenberg Traurig.

Wynn was one of just a handful of members of the Congressional Black Caucus to vote “yes” on the final vote on the 1996 welfare reform bill. The legislation, which led to a doubling of extreme poverty, provided an enormous boon to Maximus by incentivizing the outsourcing of welfare eligibility work.

Shar Habibi, the research director of In the Public Interest, which advocates against privatization, said that Maximus’s role in Medicaid redeterminations will hollow out the government’s ability to effectively provide public services.

“When governments contract with firms like Maximus to do essential public functions like determining who is or isn’t eligible for Medicaid, the question gets raised: Does outsourcing eligibility determination-related functions compromise the integrity of the program, especially when people’s lives are at stake?” she asked. “Using contractor staff does not promote an effective, efficient, and equitable delivery of Medicaid.”

Maximus also has major contracts with the federal government to provide assistance to those seeking to enroll in Medicare, the government health insurance program for seniors and those with disabilities, as well as those looking to sign up for individual health insurance plans offered on state marketplace exchanges created under Democrats’ 2010 health care law, the Affordable Care Act.

Some people formerly on Medicaid will move to exchange-based plans, which will almost certainly result in substantially higher out-of-pocket costs.

In May, Maximus laid off seven hundred workers from its Medicare and marketplace call centers where workers were seeking to unionize with the Communications Workers of America (CWA) union. The move led CWA to file an unfair labor practice charge with the National Labor Relations Board and launch a petition to pressure secretary of Health and Human Services Xavier Becerra to investigate Maximus’s labor practices.

Meanwhile, Maximus’s government contracts to do such work have continued to expand under the Biden administration, despite the fact that Joe Biden pledged in his 2020 campaign that “I intend to be the most pro-union president leading the most pro-union administration in American history.” In September 2022, Maximus was awarded a $6.6-billion contract from the Centers for Medicare and Medicaid Services (CMS).

Samira Burns, a spokesperson for the Health and Human Services Department (HHS) which includes CMS, told me that the department has initiated a request for information process with contractors like Maximus “to seek recommendations and remain in alignment with industry best practices to ensure we continue to meet national program missions and strategies. … In recent years, there has been increasing labor concerns at certain call center locations. HHS/CMS is looking to explore ways to prevent or mitigate ongoing and future concerns.”

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: Its almost as if some states don’t want to pay billions of dollars for ineligible members. Cue outrage and pearl-clutching. But a large technology company wants you to care.

 
 

 
 

Clipped from: https://www.healthcarefinancenews.com/news/medicaid-disenrollment-happening-faster-anyone-thought-says-former-medicaid-deputy-director

“If I were a hospital administrator right now, I’d have a tent outside of every entrance, (asking) do you know if you’re still covered?” 

 
 

Karen Shields is chief client engagement officer at Gainwell Technologies.

Photo: Courtesy Gainwell Technologies

The loss of coverage for Medicaid recipients is happening faster than anyone believed it would, according to Karen Shields, chief client engagement officer at Gainwell Technologies, a large payer of Medicaid claims.

“It’s faster than we thought,” said Shields, a former deputy director for the Center for Medicaid and CHIP Services. “The call for action indicates everything thinks it’s faster.” 

The call to action is in the form of a letter sent earlier this month by Health and Human Services Secretary Xavier Becerra to governors urging them to adopt new flexibilities to minimize avoidable Medicaid coverage losses.

“The lessons learned that I took with me from my time (at CMS), being responsible for enrollment and predicting human behavior, … is that it’s hard to get people to pay attention to pay health insurance,” Shields said. “It’s because it’s not their top priority if they’re not currently sick or in pain. Insurance in general is a negative buy.” 

Not all states publicly release numbers on coverage losses. Since states began Medicaid redeterminations on April 1, over one million people in the 21 states that have reported had been disenrolled from Medicaid as of June 14, according to KFF.

The entire health and social services community must be involved in raising awareness for those who have lost coverage, to reapply within a 90-day window of opportunity to see if they still qualify for Medicaid, Shields said.

Many Medicaid recipients may not have broadband access, but most have cell phone service. A recent change in Federal Communications Commission policy allows health plans to reach out to them by text. In January, the FCC’s Consumer and Governmental Affair Bureau issued a Declaratory Ruling responding to a letter from HHS Secretary Becerra regarding government Medicaid enrollment calls and text messages.

“We can’t rely on CMS or Medicaid to do it alone,” Shields said. “The bottom line is, the level of community public awareness has to be at an all-time high. If I were a hospital administrator right now, I’d have a tent outside of every entrance, (asking) do you know if you’re still covered?”

Twitter: @SusanJMorse
Email the writer: SMorse@himss.org