Tag: Enrollment

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]: 1 million out of the 23M added= 4.3%. So far 95.7% of the Medicaid expansion aka the “PHE” remains in place. Math.

 
 

 
 

Clipped from: https://www.philasun.com/week-in-review/more-than-1-million-dropped-from-medicaid-as-states-start-post-pandemic-purge-of-rolls/

 
 

ABOVE PHOTO: Samantha Richards looks over her Medicaid papers, Friday, June 9, 2023, in Bloomington, Ind. Richards has been on Medicaid her whole life and currently works two part-time jobs as a custodian. (AP Photo/Darron Cummings)

By David A. Lieb and Andrew DeMillo

ASSOCIATED PRESS

More than 1 million people have been dropped from Medicaid in the past couple months as some states moved swiftly to halt health care coverage following the end of the coronavirus pandemic.

Most got dropped for not filling out paperwork.

Though the eligibility review is required by the federal government, President’s Joe Biden’s administration isn’t too pleased at how efficiently some other states are accomplishing the task.“Pushing through things and rushing it will lead  to eligible people — kids and families — losing coverage for some period of time,” Daniel Tsai, a top federal Medicaid official recently told reporters.

Already, about 1.5 million people have been removed from Medicaid in more than two dozen states that started the process in April or May, according to publicly available reports and data obtained by The Associated Press.

Florida has dropped several hundred thousand people, by far the most among states. The drop rate also has been particularly high in other states. For people whose cases were decided in May, around half or more got dropped in Arkansas, Idaho, Kansas, Nevada, New Hampshire, Oklahoma, South Dakota, Utah, and West Virginia.

By its own count, Arkansas has dropped more than 140,000 people from Medicaid.

The eligibility redeterminations have created headaches for Jennifer Mojica, 28, who was told in April that she no longer qualified for Medicaid because Arkansas had incorrectly determined her income was above the limit.

She got that resolved but was then told her 5-year-old son was being dropped from Medicaid because she had requested his cancellation — something that never happened, she said. Her son’s coverage has been restored, but now Mojica says she’s been told her husband no longer qualifies. The uncertainty has been frustrating, she said.

“It was like fixing one thing and then another problem came up, and they fixed it and then something else came up,” Mojica said.

Arkansas officials said they have tried to renew coverage automatically for as many people as possible and placed a special emphasis on reaching families with children. But a 2021 state law requires the post-pandemic eligibility redeterminations to be completed in six months, and the state will continue “to swiftly disenroll individuals who are no longer eligible,” the Department of Human Services said in a statement.

Arkansas Gov. Sarah Huckabee Sanders has dismissed criticism of the state’s process.

“Those who do not qualify for Medicaid are taking resources from those who need them,” Sanders said on Twitter last month. “But the pandemic is over — and we are leading the way back to normalcy.”

More than 93 million people nationwide were enrolled in Medicaid as of the most recent available data in February — up nearly one-third from the pre-pandemic total in January 2020. The rolls swelled because federal law prohibited states from removing people from Medicaid during the health emergency in exchange for providing states with increased funding.

Now that eligibility reviews have resumed, states have begun plowing through a backlog of cases to determine whether people’s income or life circumstances have changed. States have a year to complete the process. But tracking down responses from everyone has proved difficult, because some people have moved, changed contact information, or disregarded mailings about the renewal process.

Before dropping people from Medicaid, the Florida Department of Children and Families said it makes between five and 13 contact attempts, including texts, emails, and phone calls. Yet the department said 152,600 people have been non-responsive.

Their coverage could be restored retroactively, if people submit information showing their eligibility up to 90 days after their deadline.

Unlike some states, Idaho continued to evaluate people’s Medicaid eligibility during the pandemic even though it didn’t remove anyone. When the enrollment freeze ended in April, Idaho started processing those cases — dropping nearly 67,000 of the 92,000 people whose cases have been decided so far.

“I think there’s still a lot of confusion among families on what’s happening,” said Hillarie Hagen, a health policy associate at the nonprofit Idaho Voices for Children.

She added, “We’re likely to see people showing up at a doctor’s office in the coming months not knowing they’ve lost Medicaid.”

Advocates fear that many households losing coverage may include children who are actually still eligible, because Medicaid covers children at higher income levels than their parents or guardians. A report last year by the U.S. Department of Health and Human Services forecast that children would be disproportionately impacted, with more than half of those disenrolled still actually eligible.

That’s difficult to confirm, however, because the federal Centers for Medicare & Medicaid Services doesn’t require states to report a demographic breakdown of those dropped. In fact, CMS has yet to release any state-by-state data. The AP obtained data directly from states and from other groups that have been collecting it.

Medicaid recipients in numerous states have described the eligibility redetermination process as frustrating.

Julie Talamo, of Port Richey, Florida, said she called state officials every day for weeks, spending hours on hold, when she was trying to ensure her 19-year-old special-needs son, Thomas, was going to stay on Medicaid.

She knew her own coverage would end but was shocked to hear Thomas’ coverage would be whittled down to a different program that could force her family to pay $2,000 per month. Eventually, an activist put Talamo in contact with a senior state healthcare official who confirmed her son would stay on Medicaid.

“This system was designed to fail people,” Talamo said of the haphazard process.

Some states haven’t been able to complete all the eligibility determinations that are due each month. Pennsylvania reported more than 100,000 incomplete cases in both April and May. Tens of thousands of cases also remained incomplete in April or May in Arizona, Arkansas, Indiana, Iowa, New Mexico, and Ohio.

“If states are already behind in processing renewals, that’s going to snowball over time,” said Tricia Brooks, a research professor at the Georgetown University Center for Children and Families. “Once they get piles of stuff that haven’t been processed, I don’t see how they catch up easily.”

Among those still hanging in the balance is Gary Rush, 67, who said he was notified in April that he would lose Medicaid coverage. The Pittsburgh resident said he was told that his retirement accounts make him ineligible, even though he said he doesn’t draw from them. Rush appealed with the help of an advocacy group and, at a hearing this past week, was told he has until July to get rid of about $60,000 in savings.

Still, Rush said he doesn’t know what he will do if he loses coverage for his diabetes medication, which costs about $700 a month. Rush said he gets $1,100 a month from Social Security.

In Indiana, Samantha Richards, 35, said she has been on Medicaid her whole life and currently works two part-time jobs as a custodian. Richards recalled receiving a letter earlier this year indicating that the pandemic-era Medicaid protection was ending. She said a local advocacy group helped her navigate the renewal process. But she remains uneasy.

“Medicaid can be a little unpredictable,” Richards said. “There is still that concern that just out of nowhere, I will either get a letter saying that we have to reapply because we missed some paperwork, or I missed a deadline, or I’m going to show up at the doctor’s office or the pharmacy and they’re going to say, ‘Your insurance didn’t go through.'”

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]: Please stop following the new rules and guidance we gave you on how to restart following the old rules. Or at least do it with less gusto.

 
 

Clipped from: https://www.13abc.com/2023/06/13/biden-administration-urges-states-slow-down-dropping-people-medicaid/

 
 

FILE – Health and Human Services Secretary Xavier Becerra speaks during a meeting with a task force on reproductive health care access in the Roosevelt Room of the White House, April 12, 2023, in Washington. The Biden administration on Monday, June 12, urged states to slow down their purge of Medicaid rolls, citing concerns that large numbers of lower-income people are losing health care coverage because of administrative reasons. “I am deeply concerned with the number of people unnecessarily losing coverage, especially those who appear to have lost coverage for avoidable reasons that State Medicaid offices have the power to prevent or mitigate,” Becerra wrote in a letter Monday to governors. (AP Photo/Evan Vucci, File)(AP)

By The Associated Press and DAVID A. LIEB

Published: Jun. 12, 2023 at 9:22 PM CDT

 
 

EFFERSON CITY, Mo. (AP) — The Biden administration on Monday urged states to slow down their purge of Medicaid rolls, citing concerns that large numbers of lower-income people are losing health care coverage due to administrative reasons.The nation’s Medicaid rolls swelled during the coronavirus pandemic as states were prohibited from ending people’s coverage. But that came to a halt in April, and states now must re-evaluate recipients’ eligibility — just as they had been regularly required to do before the pandemic.

In some states, about half of those whose Medicaid renewal cases were decided in April or May have lost their coverage, according to data submitted to the Centers for Medicare & Medicaid Services and obtained by The Associated Press. The primary cause is what CMS describes as “procedural reasons,” such as the failure to return forms.

“I am deeply concerned with the number of people unnecessarily losing coverage, especially those who appear to have lost coverage for avoidable reasons that State Medicaid offices have the power to prevent or mitigate,” Health and Human Services Secretary Secretary Xavier Becerra wrote in a letter Monday to governors.

Instead of immediately dropping people who haven’t responded by a deadline, federal officials are encouraging state Medicaid agencies to delay procedural terminations for one month while conducting additional targeted outreach to Medicaid recipients. Among other things, they’re also encouraging states to allow providers of managed health care plans to help people submit Medicaid renewal forms.

Nobody “should lose coverage simply because they changed addresses, didn’t receive a form, or didn’t have enough information about the renewal process,” ecerra said in a statement.

States are moving at different paces to conduct Medicaid eligibility determinations. Some haven’t dropped anyone from their rolls yet while others already have removed tens of thousands of people.

Among 18 states that reported preliminary data to CMS, about 45% of those whose renewals were due in April kept their Medicaid coverage, about 31% lost coverage and about 24% were still being processed. Of those that lost coverage, 4-out-of-5 were for procedural reasons, according to the U.S. Department of Health and Human Services.

In Arkansas, Florida, Idaho, New Hampshire and Oklahoma, about half or more of those whose eligibility cases were completed in April or May lost their Medicaid coverage, according data reviewed by the AP. Those figures may appear high because some states frontloaded the process, starting with people already deemed unlikely to remain eligible.

CMS officials have specifically highlighted concerns about Arkansas, which has dropped well over 100,000 Medicaid recipients, mostly for not returning renewal forms or requested information.

Arkansas officials said they are following a timeline under a 2021 law that requires the state to complete its redeterminations within six months of the end of the public health emergency. They said Medicaid recipients receive multiple notices — as well as texts, emails and phone calls, when possible — before being dropped. Some people probably don’t respond because they know they are no longer eligible, the state Department of Human Services said.

Republican Gov. Sarah Huckabee Sanders has dismissed criticism of the state’s redetermination process, saying Arkansas is merely getting the program back to its pre-pandemic coverage intentions.

But health care advocates said it’s particularly concerning when states have large numbers of people removed from Medicaid for not responding to re-enrollment notices.

“People who are procedurally disenrolled often are not going to realize they’ve lost coverage until they show up for a medical appointment or they go to fill their prescription and are told you no longer have insurance coverage,” said Allie Gardner, a senior research associate at the Georgetown University Center for Children and Families.

__

Associated Press writer Andrew DeMillo contributed from Little Rock, Arkansas.

Copyright 2023 The Associated Press. All rights reserved.

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From <https://www.13abc.com/2023/06/13/biden-administration-urges-states-slow-down-dropping-people-medicaid/>

 
 

 
 

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]: The PHE added about $117B in fed money via the increased FMAP. Did it go to clear waiting lists? Did it go to increase provider rates? Or maybe it went to ACA-ish rate cells? With the witchcraft that is Medicaid math- We may never know (and we seem to like it that way).

 
 

 
 

Clipped from: https://www.kff.org/medicaid/issue-brief/fiscal-implications-for-medicaid-of-enhanced-federal-funding-and-continuous-enrollment/

For a three-year period, states provided continuous enrollment in Medicaid in exchange for an increase in the percentage of Medicaid spending that is paid for by the federal government (the Federal Medical Assistance Percentage or “FMAP”). A recent KFF analysis estimated that over 23 million people gained Medicaid coverage during the continuous enrollment period. Beginning April 1, 2023, states could begin disenrolling individuals from Medicaid, but phased-down federal matching funds will be available through the end of the year if states comply with certain rules. While there remains a great deal of uncertainty as to how Medicaid enrollment will change during the unwinding, the end of the Medicaid continuous enrollment provision and enhanced FMAP are expected to have a significant impact on Medicaid enrollment and spending. This brief examines how Medicaid spending changed during the continuous enrollment period and estimates the amount of enhanced federal funding states received during the continuous enrollment period. Key findings include:

• State spending dipped below pre-pandemic levels even as Medicaid enrollment increased by 23 million during the continuous enrollment period. With the substantial enrollment growth, total spending increased, including significant increases in federal Medicaid spending due to the enhanced FMAP.
  
• We estimate states received over $117 billion from the increased FMAP during the continuous enrollment period, with enhanced federal funds comprising a larger share of total Medicaid spending in states that had not adopted Medicaid expansion through the Affordable Care Act (ACA).
  
• Although the magnitude is uncertain, significant decreases in Medicaid enrollment are expected during the unwinding of the continuous enrollment provision, which will result in lower Medicaid spending. Even with lower enrollment, state spending will likely increase as the enhanced FMAP expires.
  
• The phase down of the enhanced FMAP was designed to provide continued financial support to states during the unwinding process and to mitigate sharp increases in state Medicaid spending. How much state Medicaid spending increases as the enhanced FMAP phases down and is ultimately eliminated next year will depend on how many and how quickly people are disenrolled, how many new people come on to Medicaid, and how spending per person in the Medicaid program will change.
  

What was the purpose of the enhanced federal Medicaid match rate?

States received a 6.2 percentage point FMAP increase in exchange for keeping individuals continuously enrolled during the pandemic as authorized by the Families First Coronavirus Response Act (FFCRA). The increased FMAP was retroactive to January 1, 2020 and generally applied to Medicaid spending that would otherwise reimbursed at the state’s regular FMAP. The enhanced federal matching funds do not apply to administrative expenses or to Medicaid spending that is already subject to an increased match, including spending for ACA expansion adults (the FMAP is 90% for adults eligible through expansion). The Consolidated Appropriations Act, 2023 (CAA) delinked the continuous enrollment provision from the public health emergency (PHE), ending continuous enrollment on March 31, 2023. The CAA also phases down the enhanced federal Medicaid matching funds through December 2023, with the increased FMAP decreasing to 5 percentage points from April to June 2023, 2.5 percentage points from June to September 2023, and 1.5 percentage points from October to December 2023.

The federal funding from the enhanced FMAP was designed to support the costs of increased Medicaid enrollment and provide fiscal relief to states beyond the costs of enrollment growth. During economic downturns, enrollment in Medicaid grows, increasing state Medicaid costs while state tax revenues are declining. Congress enacted legislation to temporarily increase the federal share of Medicaid during the last two economic downturns prior to the pandemic. At the onset of the COVID-19 pandemic, states were projecting large revenue declines, but the enhanced FMAP provided new federal funding to states quickly by using an existing federal funding mechanism. Enhanced federal funding supported state Medicaid programs and helped free up state funds for other purposes including mitigating the need for widespread spending cuts on other services and filling gaps in state budget shortfalls.

How did Medicaid spending change during the pandemic?

State spending on Medicaid dipped below pre-pandemic levels even as enrollment in Medicaid increased by 23 million during the continuous enrollment period (Figure 1). The reduction in state spending reflected a sharp drop from $231 billion in 2019 to $214 billion in FY 2020, accompanied by an increase in federal spending of nearly $50 billion (from $393 billion to $444 billion). After 2020, state spending remained relatively stable while federal spending continued to increase due to the enhanced FMAP and total spending increased in conjunction with rising enrollment. State spending remained below 2019 levels in both expansion (defined as those having implemented Medicaid expansion as of 10/1/2021) and non-expansion states through the end of FY 2022. In the first six months of FY 2023—before the end of the continuous enrollment provision—we find that total and federal spending continued to increase while state spending returned to levels similar to the first two quarters of 2019. We expect spending and enrollment levels for the second half of 2023 to change, reflecting the end of the continuous enrollment period.

How much did states receive in enhanced federal funding during the continuous enrollment period?

During the continuous enrollment period, we estimate that states received over $117 billion in funding from the increased FMAP, with non-expansion states receiving a disproportionate share (Figure 2 and Appendix Table 1). Non-expansion states received 27% of the enhanced funding despite accounting for only 22% of all Medicaid spending because the enhanced FMAP does not apply to spending for people eligible through an ACA expansion. Across all states, the $117 billion in additional funding comprised an estimated 5% of total Medicaid spending and 7% of federal Medicaid spending during the continuous enrollment period (January 2020 through March 2023).

What might happen to Medicaid spending during the unwinding?

Although the size of the effects are quite uncertain, significant decreases in Medicaid enrollment are expected during the 14-month period in which states unwind the continuous enrollment period. KFF estimates that nationally Medicaid enrollment will decrease by 18% (17 million people) between March 2023 and May 2024 (based on a recent survey of states), but in practice, rates of enrollment decline will vary across states, depending on states’ approaches to unwinding. Early data from states shows substantial variation in disenrollment rates. While state Medicaid agencies report enrollment changes as the most significant factor driving changes in total Medicaid spending, they also note that factors such provider payment rate increases were putting upward pressure on spending. Overall, total Medicaid spending could decrease during the unwinding if the effects of enrollment losses are larger than the effects of other factors such as those.

Even with declining enrollment, state spending on Medicaid will likely increase as the enhanced FMAP expires. States are expecting the end of the enhanced FMAP to shift the state and federal spending shares, as has been the case in previous economic downturns when an enhanced FMAP expired. CBO estimates that federal spending will decrease by about 9% from FY 2023 to FY 2024. While states received substantial enhanced federal funding of $117 billion during the continuous enrollment period, they will likely see increases in state Medicaid spending as the enhanced federal matching funds expire at the end of the year.

The phase down of the enhanced FMAP was designed to provide continued financial support to states during the unwinding process and to mitigate sharp increases in state Medicaid spending. Before the CAA delinked the continuous enrollment provision and the enhanced FMAP from the PHE, the enhanced FMAP was set to expire at the end of the quarter when the PHE expired. The gradual phase-out of the FMAP through December 2023 recognizes that it will take states time to unwind the continuous enrollment provision and conduct redeterminations for all Medicaid enrollees. To be eligible for the enhanced match, states must meet certain eligibility, renewal, and reporting requirements. Recently, in a letter to CMS, Democratic lawmakers reiterated these beneficiary protections as well as CMS enforcement tools that were made available in the CAA, and CMS, in a letter to state governors, reiterated that states must comply with federal requirements to continue to draw down enhanced federal funds. The amount of the enhanced funding available to states during the unwinding will be smaller relative to the continuous-enrollment period, but it will still help mitigate the shift in funding from the federal government back to the states. As the enhanced federal funding is phased out and ultimately eliminated, the size of the increase in state Medicaid spending will depend on changes in total spending growth, which in turn will reflect how quickly people are disenrolled, how many new people come on to Medicaid, and how spending per person in the Medicaid program will change. These enrollment and spending changes will vary by state.

Appendix

 
 

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]: Oregon shows that the wind-down can be done without everyone losing their minds. This is the way.

 
 

Clipped from: https://ktvz.com/news/government-politics/2023/05/23/early-numbers-show-nearly-70-of-oregonians-keep-oregon-health-plan-benefits-in-first-round-of-renewals/

 
 

Oregon Health Authority

SALEM, Ore. (KTVZ) – The Oregon Health Authority and Oregon Department of Human Services are committed to transparency and will be sending monthly information about medical coverage among Oregonians as the agencies continue to track the state’s progress in determining eligibility for medical programs.

Background

When the COVID-19 pandemic began, the federal government allowed states to keep people on Medicaid once they became eligible and did not require annual eligibility renewals. During this historic health emergency, the Oregon Health Plan (OHP), Oregon’s Medicaid program, grew to nearly 1.5 million people.

In April, Oregon began the process of redetermining eligibility for everyone on OHP.  While most people will continue to qualify for existing benefits, OHA is required to review eligibility for all OHP and Medicare Savings Program (MSP) members by mid-2024.

OHP redeterminations started in April

In April, Oregon began processing eligibility redeterminations for all 1.5 million members receiving OHP and other Medicaid-funded services and supports. The federal government requires Oregon to disenroll any members who are no longer eligible or fail to respond to renewal notices.

All OHP households will receive a renewal notice over the next 10 months. People are encouraged to check that their contact information is up to date so that they can be contacted by the state and receive renewal notices.

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Oregon will be able to process many renewals automatically. This means that every OHP member will receive a renewal notice, and the notice will explain whether the member needs to provide additional information or take action to keep their coverage.

OHP members encouraged to respond quickly

Although the state has taken many steps to prepare, the large number of OHP redeterminations, along with renewals of long-term services and supports, is expected to cause greater wait times, delays, and possible interruptions to people’s OHP benefits. OHP members are encouraged to respond as quickly as possible after they receive a request for information to avoid any possible delays. The fastest way members can provide an update is by going to benefits.oregon.gov and logging into their ONE account.

Members losing OHP coverage have other coverage options and will receive at least 60 days advance notice. Many people will be eligible to enroll in health plans through the Oregon Health Insurance Marketplace (OHIM) with financial help. Other people may be eligible for Medicare or employer coverage.

April OHP redeterminations data

• April was the first month Oregon began processing medical renewals, during this reporting period: 133,232 individuals, or 75,436 cases have had their OHP renewed.
  
• 46,894 individuals, or 29,072 cases needed to provide more information to complete the process.
  
• 13,208 required individuals to review, sign and send back their renewal packet.
  
• 8,394 people were ineligible and received a 60-day notice of termination of coverage. When people are ineligible, they are referred to the Oregon Health Insurance Marketplace for other options for health care coverage.
  

Early data for May shows 66% of people will retain benefits.

Members losing coverage should report changes to their income or household information immediately if any of the information used to make the decision is inaccurate. They also should apply for other health coverage as soon as they know their coverage ending date to prevent a gap in coverage.

Data dashboards in place for tracking progress

Two new dashboards became available in April for the public to track Oregon’s progress.

• Medical Redeterminations Dashboard for tracking the state’s progress in determining eligibility for medical programs. This dashboard is updated daily. The types of data in this dashboard will expand over the next few months.
  
• ONE Customer Service Center Dashboard for monitoring the customer service experience for people calling the ONE Customer Service Center to apply for or ask for help with medical, food, cash and child care benefits. The ONE Customer Service Center Dashboard is updated every day.
  

Extending health coverage

To get help, people can also:

• Learn more about how to renew your Oregon Health Plan medical coverage.
  
• Call the ONE Customer Service Center: 800-699-9075 (all relay calls are accepted, and help is available in multiple languages).
  
• Stop by a local ODHS office or Area Agency on Aging Office. People can find their local office at: https://www.oregon.gov/dhs/Offices/Pages/one-services.aspxm
  
• Visit a community partner for free, in-person help. To find one near you visit https://oregonhealthcare.gov/GetHelp (English) or orhim.info/ayuda (Spanish).
  

Get help finding other health coverage at OregonHealthCare.gov/GetHelp

 
 

 
 

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]: The state of Arkansas just saved $2M in state funds per month by carefully removing people who are no longer authorized to receive tax-payer funded Medicaid benefits. MCOs lost about $100k in profit / month from the move.

 
 

 
 

Clipped from: https://www.ualrpublicradio.org/local-regional-news/2023-05-09/arkansas-disenrolls-44-667-extended-medicaid-beneficiaries-72-802-total

 
 

The Arkansas Department of Human Services said it disenrolled 44,667 Medicaid beneficiaries whose coverage had been extended because of the COVID-19 public health emergency in the month of April – the first month Arkansas could do so under federal rules.

Another 28,135 cases were closed as part of DHS’s normal operations, bringing the total for the month to 72,802. The department said in a press release that it averaged 25,000 monthly disenrollments in 2018 and 2019 before the pandemic began. Among the cases due in April, coverage was renewed for 61,236 beneficiaries.

Arkansas stopped disenrolling most Medicaid beneficiaries after former President Donald Trump on March 18, 2020, signed the Families First Coronavirus Response Act. It increased federal Medicaid matching funds for states that kept all individual cases active during the public health emergency.

DHS this month started making the removals as a result of the federal Consolidated Appropriations Act, signed into law last December. It allowed states after March 31 to begin dropping Medicaid recipients who are no longer eligible. Normal eligibility rules, set by Congress and the Centers for Medicare and Medicaid Services, resumed April 1. All beneficiaries who have not had a renewal in the last 12 months will be redetermined. State law requires that the work be completed in six months.

A press release said the department expects enrollment to continue to decline in the coming months. Enrollment is still 145,475 beneficiaries higher than it was at the beginning of the pandemic. It was 921,066 on March 31, 2020. On May 1, it was 1,066,541. The state’s Medicaid numbers rose by 230,000 total during the pandemic.

Broken down by category of assistance, 18,561 of the disenrolled extended beneficiaries were part of the ARHOME program, the state’s Medicaid expansion program created under Obamacare. Another 9,662 ARHOME beneficiaries lost their coverage because of regular DHS operations. Coverage was removed from 14,242 extended beneficiaries in the ARKids First A program, the program that serves children. Another 9,595 cases were closed as part of regular operations. In the ARKids First B program, which serves children whose parents make too much money to qualify for regular Medicaid, there were 1,085 extended cases and 778 regular cases closed.

One of the two other categories of beneficiaries were those who were served by the Parents or Other Caretaker Relative program, which covers adults with related minor children in the home for whom they exercise care. In that category, 7,944 extended cases and 4,962 regular cases were closed.

Finally, the state’s newborn program provides full coverage to children up to age 1 whose mothers were eligible for services at the time of their birth. They are guaranteed coverage their first year of life regardless of income changes occurring in the home. In that category, 1,085 extended cases and 778 regular cases were closed.

By far the most common reason for closing a case was the failure of recipients to return the renewal form. That was 44,714 total cases and included 35,625 extended cases and 9,089 regular cases. The other reasons for closure were as follows.
• Failure to return requested information: 7,673 total; 1,596 extended; 6,077 regular
• Client requested closure: 5,791 total; 2,685 extended; 3,106 regular
• Household income is above limit for household size: 5,414 total; 1,485 extended; 3.929 regular
• Unable to locate – returned mail: 2,024 total; 739 extended; 1,285 regular

DHS began ramping up its preparations for the unwinding in January 2022. It has tested its systems through a variety of scenarios. Testing will continue throughout the process. More than a year ago, it contracted temporary workers to help with eligibility determinations. It has made phone calls, met with providers and others, and conducted awareness campaigns to try to inform beneficiaries of the change.

Last month, Mary Franklin, director of the DHS Division of County Operations, said at a webinar sponsored by Arkansas Advocates for Children and Families that the state continued to process applications and renewals throughout the three years of the public health emergency but kept individuals enrolled even when their incomes exceeded eligibility limits, when they didn’t respond to DHS communications, when their level of care for long-term supports changed, or when they aged out of eligibility. aCases were closed when individuals died, were incarcerated, moved out of state or asked to be removed.

The department said disenrolled beneficiaries can access insurance from other sources, including their employer or through the health insurance marketplace. The disenrolled can appeal the disenrollment and can get more information at this link.
 

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]: In which the world’s superpower tells us about how much Medicaid eligibility processes are bad. Published by the official Central Propaganda Department of the CCP (not making that up).

 
 

Clipped from: https://news.cgtn.com/news/2023-05-10/-I-can-neither-afford-commercial-insurance-nor-get-Medicaid-benefits–1jGRFo87Khy/index.html

 
 

Translating…

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In February 2023, the World Economic Forum released statistics showing that “health care spending is significantly higher in the U.S. than anywhere else in the world.” According to a survey by Gallup in December 2022, nearly 40 percent of American adults have experienced difficulties in paying healthcare bills and accessing affordable and quality medical services, and most of them consider medical expenses a source of daily stress.

Marvel, 28, has been suffering from Lyme disease since high school. The disease requires him to constantly keep tabs on his own health problems. Unable to afford expensive commercial insurance, he tried applying for subsidized health insurance, but was given misleading information by local health authorities. “I am basically without any tool to facilitate my own health,” said Marvel.

 
 

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 details on Georgia’s plan to comply with federal requirements to return to normal operations by resuming eligibility oversight processes for Medicaid members who may longer be eligible.

 
 

Clipped from: https://www.timesfreepress.com/news/2023/may/06/up-to-500000-at-risk-as-georgians-must-requalify/

 
 

Georgia Gov. Brian Kemp signs a bill allowing a state health insurance marketplace into law at the state Capitol on Tuesday, May 2, 2023, in Atlanta. Georgia’s state government will for the first time run its own marketplace for individual health insurance under the bill signed by Kemp. (AP Photo/Jeff Amy)

 
 

Some people know what Alysia Cutting is talking about when she brings up Medicaid unwinding as she moves from one community event to the next in southwest Georgia.

But for most of them, word of the renewal process starting up again — and the potential they could lose Medicaid coverage — is news to them.

Medicaid renewals are back after a three-year hiatus during the pandemic, when states were barred from kicking people off the public insurance program during the COVID-19 crisis.

And the yearlong process of determining the eligibility of all 2.7 million adults and children covered by Medicaid started last month could end with more than a half million Georgians losing coverage because they no longer qualify.

When she catches someone unaware, Cutting quickly fills them in on what’s happening, directs them to the state’s staycovered.ga.gov site and tries to convey a sense of urgency as she sends them on their way with a flier in English and Spanish.

“Please make sure you do this. It’s super, super important. It’s really urgent. Make sure you get this done,” Cutting, who is the rural health equity director with SOWEGA Rising, said of her message.

On a recent Saturday, Cutting was spreading the word at a health fair held at a public housing community in Albany, where a financial incentive was being offered for anyone who received their first COVID-19 vaccine or booster.

Most Sundays, you will find Cutting visiting places of worship in the area as she tries to work information about Medicaid redetermination into announcements to the congregation and into church bulletins. Another key strategy to reaching people in her corner of the state: Getting the information posted at barbershops, salons and other small businesses.

She attempts to amplify the message state agencies have been pushing for several months: Make sure your contact information is up to date in your Georgia Gateway account.

“People have moved. People have relocated. Situations have changed,” Cutting said. “It’s a lot. I just would not want for someone’s mailbox to have a little letter in there, and they’ve moved and now they’re sleeping at their grandmother’s house because they lost the apartment or lost the house.”

Navigating the process

The 2.7 million renewals are being handled as about a dozen batches, with the first group of people mailed notices in mid-April. This work will be underway through next May.

The state sent out nearly 7,500 renewal notices last month, but most of the groupings will be about 250,000 each, according to the state Department of Human Services. Medicaid enrollees can see their scheduled renewal date in their Gateway account.

This massive multi-agency undertaking will mostly fall to an army of caseworkers with the Division of Family and Children Services within Human Services. About $8.4 million was added to this year’s budget and another $11 million was pumped into next year’s budget to increase staffing and purchase technology to support the workload.

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But low public awareness has also presented a challenge nationally. In December, more than six in 10 adults in Medicaid-enrolled families said they were not aware that the regular renewal process was restarting, according to a survey from the Urban Institute.

A major focus for the state has been to put the looming renewal on the radar of those covered by Medicaid while directing them to update their contact information in their Georgia Gateway account so they will receive important notices when it is their turn to go through the process.

The department contracted with Atlanta-based Jackson Spalding last June to lead Georgia’s statewide public information campaign, including a series of ads featuring an animated “spokespeach” named George A. Peach.

The contract with the firm allows it to spend up to $5 million on this work in the first year, according to its contract with the state.

The statewide marketing campaign has so far included social media, TV, radio and digital ads, billboards, direct mail outreach, printed materials, and text message outreach. The state’s unwinding website includes resources available in Spanish, Burmese, Korean and other languages.

The state is also working with the three care management organizations that provide Medicaid benefits, notifying them which of their members are up for redetermination.

Jason Bearden, president of CareSource Georgia, said his organization is attempting to reach out to those members — or talk to them when they initiate communication — to discuss the process and their coverage options. CareSource, which provides Medicaid benefits for about a half million Georgians, offers private insurance plans through the federal marketplace.

CareSource’s community educators are also setting up at local events and on major hospital campuses like Grady Health and Northeast Georgia Health System to catch enrollees as they use their benefits.

Bearden said public awareness about important health care events is always a concern. He lauded the state for putting money into a public relations and marketing campaign to try to boost awareness.

“Us policy wonks, we get it. But we have got to do a really good job of getting the word out there,” Bearden said.

“Is it perfect? No. Can we always do more? Yes. But it is a big concern to all of us around awareness and what do I need to do, because it’s complex — why is eligibility anchored to all these different variables? Income, job status, family size — it’s confusing.”

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The state has provided an online toolkit and other information for groups like SOWEGA Rising to use as they assist their communities.

But other states have gone further. For example, Arkansas has offered small grants to community organizations to reach more people and help them through what many advocates describe as a thorny process.

“Knowing about it is one thing, and navigating the process is another thing,” said Callan Wells, senior health policy manager with the Georgia Early Education Alliance for Ready Students.

Kylie Winton, communications director with DHS, said other plans are in the works to partner with local organizations that can often act as a trusted messenger in their community, as seen during the pandemic.

Automation

Behind the scenes, state officials say there is work underway to renew coverage when possible without all the tedious back-and-forth exchange of paperwork.

Caseworkers will attempt to determine a Medicaid enrollee’s status with the data already on file, although it remains to be seen how many people’s eligibility can be redetermined this way.

The federal government is pushing states to lean on this method.

Caylee Noggle, commissioner of state Department of Community Health, which administers the state’s Medicaid program, told the agency’s advisory board in April that the state agencies will first try to use this method — known as an ex parte renewal.

“I don’t know exactly what we’ll hit. We’re trying to increase our ability to be really effective at that. But we’re going to shoot for as high as we can get,” Noggle said.

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There’s room for improvement, advocates say. In 2019, Georgia was one of 22 states where less than half of renewals were done using available data sources, according to a Kaiser Family Foundation survey.

Maximizing this strategy benefits both enrollees and Division of Family and Children Services employees, who are toiling in roles in state government with historically high turnover, says Leah Chan, senior health analyst with the Georgia Budget and Policy Institute.

“This process — that is already fraught even in the best of circumstances — relies on this workforce that I don’t think is getting all of the support it needs in our state budget, and so, that’s one of the reasons this ex parte is so critical,” Chan said. “If we can take a little bit of the pressure off that frontline Division of Family and Children Services workforce, it could reduce the risk for human error being made.”

The renewal process can be arduous, requiring multiple steps and supporting documentation in a short 45-day period. If an enrollee believes they have been denied coverage in error, they can appeal the decision.

But Wells with the Georgia Early Education Alliance for Ready Students said she worries about even short breaks in coverage for young children due to “bureaucratic errors.” A lapse in care, for example, could mean missing health screenings designed to catch a developmental delay early.

Nearly 40% of Georgia children are covered by Medicaid, according to Georgetown’s Center for Children and Families.

“Even if they can reapply and get back on Medicaid, we could see gaps in coverage during this really critical time,” Wells said.

Wells said the state can minimize the number of people removed in error by utilizing those alternative data sources for renewals when possible. But in the long term, she advocates for allowing continuous Medicaid eligibility for the youngest Georgians — through age six — to avoid unnecessary coverage gaps.

“This is going to continue to be an issue beyond unwinding,” she said.

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In Georgia, 6.6% of children have no insurance, which is higher than the national average, and there is concern that number could increase because of the redetermination process, Wells said.

“I am worried about the number of families who are going to lose (coverage) because of the bureaucratic barriers, and I think that that’s missing from the conversation,” she said.

Winton with Human Services said the agency expects about three-fourths of renewals for children and adults to be able to go the automated route. Some, though, will require a manual review.

She also said the state will try at least two other methods to find someone if their renewal notice cannot be delivered to the address on file, using all available databases to find up-to-date contact information.

Medicaid enrollees also have a chance following the renewal process to submit any missing documents or information.

“If a case is closed because a member’s whereabouts are unknown or there are procedural issues with their renewal, the member has 90 days to provide additional information to verify their eligibility,” Winton said.

‘We will see very large coverage losses’

The earliest anyone is likely to lose Medicaid coverage under the state’s timeline for the unwinding is June 1.

That’s when Cynthia Gibson says she expects the phones at Georgia Legal Services Program to start lighting up.

Georgia Legal Services Program, which provides free assistance to those outside of metro Atlanta, will help someone submit an appeal if they believe their coverage was denied in error. The organization also runs a federally funded program called Georgia Enroll that can help people who are no longer eligible for Medicaid find coverage.

“Our expectation is that we’re going to get a lot of calls once the terminations start,” said Gibson, who is a managing attorney and a health law specialist with the program.

“And we expect there’s going to be people who never get the notices, and so they’re not going to know about their termination until they try to use their insurance and then they’re going to find out they don’t have it.”

Gibson said the organization anticipates a “large need” to represent those affected by the redetermination process, whether it’s filing an appeal or signing up for an insurance plan on the marketplace because they no longer qualify for Medicaid.

(READ MORE: In Tennessee, a Medicaid mix-up could land you on a ‘most wanted’ list)

Adding to the confusion is the question of whether Georgia’s new Medicaid plan — Georgia Pathways to Coverage — will launch as planned this July.

Gov. Brian Kemp’s narrower alternative to traditional Medicaid expansion has been delayed by legal challenges and pushback from the Biden administration, which did not appeal a federal judge’s opinion that sided with the state.

When Kemp’s plan was first unveiled, about 50,000 people were estimated to gain coverage. The agency now projects about 345,000 people may be eligible, according to Fiona Roberts, press secretary for the Department of Community Health.

“Georgia Pathways is expected to launch on July 1, 2023. DCH continues to work with (the Centers for Medicare and Medicaid Services) and its partners to be ready to implement on the go-live date,” Roberts said in a statement.

Low-income adults can qualify for coverage through the new Medicaid program if they complete 80 hours of a qualifying activity, such as working, attending school, or volunteering every month — a controversial condition known as a work requirement.

But patient and health care advocates warn that the risk of significant numbers of people becoming uninsured is greater in states like Georgia, which is now one of 10 states that have not fully expanded Medicaid under the Affordable Care Act.

North Carolina lawmakers voted to change course this year, becoming the first neighboring Southern state to expand Medicaid.

“There will be far fewer uninsured folks as a result of this Medicaid renewal process in states with Medicaid expansion. Georgia is not one of those, so we will see very large coverage losses,” Laura Colbert, executive director of Georgians for a Health Future, which is a nonpartisan patient advocacy group, said during a recent Protect Our Care program.

Colbert said the state agencies have made “really good faith efforts to plan as best they can,” but noted that it falls to the governor and lawmakers to ensure they have the resources they need.

But even with additional funding this year, attracting and training enough workers for this complex task that is already underway will be a challenge in the current labor environment, she said.

That hiring is ongoing. Winton with DHS said the agency just onboarded 276 new employees, with more people in the pipeline, and said there are early signs the agency’s turnover rate for the role of economic support specialist is trending lower.

Read more at GeorgiaRecorder.com.