States of Unwinding: December 8, 2023
Eight months into unwinding, states are now more than half way through redeterminations. In an effort to preserve coverage for children, Rhode Island postponed redeterminations for households with children until December 1. Maine continues to pause procedural terminations while it makes improvements to ex parte processes and Oregon took steps to reinstate coverage to address issues with its renewal process. Additionally, Minnesota shared its plan for implementing ex parte at the individual level. And in an effort to streamline enrollment, Maryland is seeking to leverage federal flexibilities and is requesting from CMS to implement express lane eligibility.
In an effort to reach all eligible members, Arizona is encouraging everyone who receives a renewal form to complete it, irrespective of their income. Other outreach and communication efforts being employed by Medicaid and Marketplace agencies include a multi-platform communications campaign in Georgia while Maine’s Marketplace is making outbound calls to individuals who have lost Medicaid coverage.
Lastly, states continue to update their data dashboards and make information about unwinding public. Several states are highlighting the total numbers of individuals for whom coverage has been preserved, and Wisconsin launched a new interactive dashboard. Maine is now reporting transitions of individuals no longer eligible for Medicaid to Marketplace coverage. State Health and Value Strategies continues to track states publishing data through our expert perspective, which includes an interactive map, and also continues to monitor data on transitions to State-Based Marketplace coverage during the unwinding. SHVS also published a new expert perspective that reviews current state reporting of reinstatement data and provides recommendations for the reporting of such data. As a reminder, SHVS has created a one-stop resource page to support states as they plan for and implement unwinding.
Efforts to Preserve Coverage for Children
Rhode Island postponed renewals of households with children until December 1. The Rhode Island Executive Office of Health and Human Services, in partnership with the Department of Human Services and HealthSource RI, announced at Progreso Latino in Central Falls that Medicaid renewals for households with children will restart on December 1. Rhode Island chose to delay renewals for households with children to allow more time for outreach and preparation.
Pausing Procedural Terminations and Coverage Reinstatements
Maine is pausing procedural terminations while it makes improvements to ex parte. The Department of Health and Human Services (DHHS) continues to suspend disenrolling members for the “procedural” reason of not returning their renewal form to prevent individuals and families from losing coverage unnecessarily as improvements are made to the state’s ex parte eligibility system.
Oregon is addressing issues with the renewal process by extending coverage for certain groups. The Oregon Health Authority (OHA) is extending coverage through the end of the year for approximately 11,700 members who received incorrect approval notices and reinstated coverage for around 1,900 people whose benefits were incorrectly ended in September. The Oregon Department of Human Services (ODHS) has paused closures and is restoring coverage to 20,000 people found over the income limits for the Oregon Supplemental Income Program—Medical (OSIPM) benefits. OSIPM is a program that provides Oregon Health Plan (OHP) coverage to Oregonians who are legally blind, have a disability, and/or are 65 or older and have limited income and financial resources. ODHS is updating OSIPM renewal notices with more information about members’ options to potentially remain eligible so they can have additional time to report changes and keep their benefits if still eligible.
Implementation of Individual Ex Parte
Minnesota released a plan for conducting ex parte at the individual level. The Minnesota Department of Human Services issued a bulletin providing information about Mitigation Plan 2.0 to conduct ex parte renewals at the individual level, the return to standard eligibility policies following renewal, and the reconsideration periods for renewal cohorts during the unwinding period. The ongoing mitigation strategies will be in place until IT systems and processes are updated to conduct individual level ex parte renewals.
Leveraging Federal Flexibilities
Maryland is requesting to implement Express Lane Eligibility. Maryland submitted a request to CMS to amend its section 1115 demonstration, entitled “Maryland Health Choice,” to establish an express lane eligibility program to utilize data from the Supplemental Nutrition Assistance Program for Medicaid redeterminations.
Medicaid and Marketplace Communication and Outreach Efforts
Arizona is encouraging enrollees to complete their renewal forms even if they are income ineligible. The Arizona Health Care Cost Containment System (AHCCCS) is asking members to complete their renewal form regardless of their income. AHCCCS is encouraging members, especially parents, to complete their renewal request, even if they do not think they will qualify as their children may still qualify for KidsCare. More than 58,000 members who have been disenrolled since April for not responding to the agency’s request for information have subsequently completed their renewal within the 90-day window and had coverage reinstated without having to start a new application.
Georgia is running a multi-platform communications campaign. The Georgia Department of Human Services (DHS) and Georgia Department of Community Health (DCH) are continuing their multi-platform campaign to reach members with information about how to stay covered. DHS and DCH are sharing action steps and resources with members through an ongoing digital advertising and social media outreach campaign that has reached 111 million impressions and through television and radio advertising that has reached 14 million impressions. DCH and DHS continue to participate in community events as well as outreach to healthcare providers and clinics.
Maine is reaching out to individuals no longer eligible for Medicaid. To help ensure individuals in Maine maintain health coverage, DHHS has engaged in a cross-cutting outreach campaign via mail, phone, text, multi-media marketing, and partnerships with community-based organizations to reach people where they are. CoverME.gov has sent a three-touch series of mailers to over 10,000 people who are no longer eligible for MaineCare coverage, and made over 6,300 outbound calls to ensure they know about Marketplace plans and the financial assistance available to help pay for premiums.
Making Information About Unwinding Public
Arizona announced that as of October, 1.1 million individuals have maintained their coverage. AHCCCS released their monthly Medicaid renewal data dashboard. Since renewals began, 1.5 million members have completed the renewal process and more than 1.1 million have maintained their healthcare coverage.
Kentucky released unwinding data for October. The Kentucky Cabinet for Health and Family Services released an unwinding demographic report for October. A total of 89,854 individuals who had their renewal due on October 31 were determined eligible for renewed coverage and 12,544 individuals were determined ineligible and had their coverage terminated. For individuals who were procedurally terminated on October 31 and have supplied requested information, 1,672 renewals have been reinstated.
Maine published data for October and is now reporting on transitions to Marketplace coverage. The Maine Department of Health and Human Services (DHHS) released updated unwinding data, available on the MaineCare Renewals Data Dashboard. From May through October 2023, over 138,000 MaineCare members were successfully renewed and retained their Medicaid coverage, including over 41,000 who were renewed through the ex parte renewal process. DHHS has started reporting unwinding transition data from CoverME.gov, the state’s official health insurance Marketplace. During the first five months of redeterminations, 10,981 people were determined ineligible for Medicaid and had their accounts transferred to the Marketplace. Of those, 1,362 people have selected Marketplace plans through the unwinding special enrollment period.
Massachusetts’ Marketplace has enrolled a total of 252,055 individuals during unwinding. The Massachusetts Health Connector, the state’s official health insurance Marketplace, released an enrollment summary of membership during MassHealth redeterminations. As of November 2, a total of 252,055 enrolled in Marketplace coverage, 157,803 of which enrolled in the ConnectorCare program and 44,841 enrolled in subsidized coverage. The enrollment report also includes information on call center operations.
Michigan published unwinding data for October. The Michigan Department of Health and Human Services released October unwinding data showing it has renewed Medicaid or Healthy Michigan plan coverage for 168,088 people whose eligibility was up for redetermination. There were 13,618 people who were disenrolled in October because they were no longer eligible and 2,806 whose eligibility was not renewed for procedural reasons.
Oregon published data showing that five out of six Oregonians retained coverage. OHA announced that 919,879 people have completed the Medicaid renewal process as of November 17. This represents 63.8% of all OHP and Medicaid members. 783,661 people (85.2%) were renewed and kept their benefits. This is a 2.7% point increase since October. 111,941 people (13%) were found ineligible. This is a 0.8% point decrease since October.
Washington published unwinding data for October. The Washington State Health Care Authority released updated unwinding data for October. 169,743 enrollees’ renewals were processed, and 45,791 members were disenrolled. Of those disenrolled, 21,628 individuals were disenrolled for not responding.
Wisconsin launched an interactive dashboard. The Wisconsin Department of Health Services updated its Medicaid Renewal Data webpage to include a new interactive dashboard. The new dashboard gives more information about how coverage is retained or ended for members in the renewal process. The dashboard currently contains data for renewals completed through October 2023. Updates to the dashboard will be published by the third Thursday of every month.