JEFFERSON CITY, Mo. (AP) — In an effort to address the growing issue of lower-income individuals losing health care coverage due to administrative reasons, the Biden administration called on states to slow down their removal of individuals from Medicaid rolls.
During the pandemic, Medicaid enrollment increased as states were not allowed to terminate coverage for individuals. However, this changed in April, and states are now required to reassess the eligibility of recipients, as was customary before the pandemic.
Data submitted to the Centers for Medicare & Medicaid Services and obtained by The Associated Press reveals that in certain states, nearly half of the individuals whose Medicaid renewal cases were evaluated in April or May have lost their coverage. The primary reason cited by CMS is “procedural reasons,” such as the failure to submit required forms.
Health and Human Services Secretary Xavier Becerra expressed deep concern regarding the unnecessary loss of coverage, particularly among those who appear to have lost it due to preventable reasons that could have been addressed or mitigated by State Medicaid offices. In a letter to governors on Monday, Secretary Becerra emphasized the need to take action to prevent these avoidable coverage losses.
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To address the issue of individuals losing Medicaid coverage due to administrative reasons, federal officials are recommending a more lenient approach. Rather than immediately terminating coverage for individuals who haven’t responded by a deadline, state Medicaid agencies are being urged to delay procedural terminations for one month. During this time, agencies should engage in targeted outreach to Medicaid recipients. Additionally, the federal officials are encouraging states to involve managed health care plan providers in assisting individuals with submitting Medicaid renewal forms.
Health and Human Services Secretary Xavier Becerra emphasized that individuals should not lose coverage simply because they have changed addresses, did not receive a form, or lacked sufficient information about the renewal process. In a statement, Becerra expressed the need for a compassionate and understanding approach.
States vary in their progress in conducting Medicaid eligibility determinations. Some states have yet to remove anyone from their rolls, while others have already eliminated coverage for tens of thousands of individuals.
Preliminary data reported to the Centers for Medicare & Medicaid Services (CMS) by 18 states reveals some key statistics regarding Medicaid coverage renewals. Out of the individuals whose renewals were due in April:
- Approximately 45% were able to retain their Medicaid coverage.
- Around 31% lost their coverage.
- Approximately 24% were still undergoing the renewal process.
Among those who lost their coverage, the U.S. Department of Health and Human Services reports that four out of five cases were due to procedural reasons. These procedural issues are likely administrative in nature, such as failure to complete required forms or provide necessary documentation.
According to data reviewed by the AP, several states including Arkansas, Florida, Idaho, New Hampshire, and Oklahoma experienced significant loss of Medicaid coverage among individuals whose eligibility cases were evaluated in April or May. In these states, approximately half or more of the individuals in question lost their Medicaid coverage.
It should be noted that these figures may appear high because some states prioritized the review process by starting with individuals who were already considered unlikely to remain eligible for Medicaid.
Concerns have been raised specifically about Arkansas, where over 100,000 Medicaid recipients have been dropped, primarily due to their failure to return renewal forms or provide requested information, as highlighted by CMS officials.
Arkansas officials have explained that they are following a timeline mandated by a 2021 law, which requires the state to complete redeterminations within six months of the end of the public health emergency. The state’s Department of Human Services stated that Medicaid recipients receive multiple notifications, including texts, emails, and phone calls, to remind them before being dropped. They further suggested that some individuals may not respond because they are aware they are no longer eligible for Medicaid.
Republican Governor Sarah Huckabee Sanders has defended Arkansas’ redetermination process, stating that the state is simply returning the program to its pre-pandemic coverage intentions.
However, health care advocates have expressed concern, particularly when a large number of individuals are removed from Medicaid due to non-response to re-enrollment notices. This disenrollment can result in individuals realizing they have lost coverage only when they seek medical care or attempt to fill a prescription and are informed that they no longer have insurance coverage.
Allie Gardner, a senior research associate at the Georgetown University Center for Children and Families, emphasized the issue of procedural disenrollment and the potential for individuals to be unaware of their loss of coverage until they require medical services.