States of Unwinding: January 19, 2024
Following the release on December 18, 2023 by the Centers for Medicare & Medicaid Services (CMS) of a suite of Medicaid unwinding-related guidance and resources focused on ensuring eligible children maintain coverage, several states announced additional efforts to preserve coverage for children. While Georgia is funding a surge campaign that includes increased staffing, North Carolina received approval from CMS to extend renewals for children by one year. As states continue to address the reinstatement of individuals whose coverage was terminated as the result of a household ex parte review, Nebraska issued a bulletin to providers on how to submit or adjust claims for affected individuals. New Jersey is partnering with community organizations to support renewals while Pennsylvania is evaluating unwinding by surveying enrollees to learn about their redetermination experience.
States continue to outreach to enrollees and communicate information about unwinding. Maryland rebranded its unwinding communications campaign to update it for 2024 while New Hampshire posted an online discussion of the Medicare Special Enrollment period.
States continue to make information about unwinding public, with states publishing data for November. Arizona announced it completed redeterminations for its COVID protected group, while Michigan highlighted that its renewal rate for November was over 70%. 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
Georgia is funding a surge campaign to support redetermination of children. The Georgia Department of Community Health and the Georgia Department of Human Services secured more than $54 million through the Governor’s Office of Planning and Budget to support ongoing Medicaid and PeachCare for Kids redetermination processing as part of a new, short-term “surge” effort. Components of the surge effort include: a team of 99 caseworkers that will focus solely on assisting eligibility staff with processing the backlog of Medicaid renewals; overtime and stipends for eligibility workers; and assigning contractors to conduct outreach to enrollees who require additional assistance.
North Carolina is extending the renewal period for all children by one year. In a memo to county managers, the North Carolina Department of Health and Human Services (NCDHHS) highlighted that it received approval of a waiver from CMS to extend eligibility for children under the age of 19 for recertifications for an additional year. NCDHHS explains that continuing healthcare coverage for children is not only in the best interest of North Carolina, but it will also help significantly reduce the immediate workload of County Department of Social Services staff.
Rhode Island hosted an information session on the redetermination process for households with children. The information session was for community health workers and anyone who helps families navigate healthcare needs in Rhode Island to learn what restarting the Medicaid redetermination process will mean for households with children and how to support families with the process. Rhode Island postponed renewals for families with children until December 2023.
Pausing Procedural Terminations and Coverage Reinstatements
Nebraska informed providers about submitting claims for individuals who are reinstated. The Nebraska Department of Human Services issued an updated provider bulletin to inform Nebraska Medicaid providers of members whose coverage has been reinstated following loss of coverage because of household ex parte review. Providers have six months to submit claims, or an adjustment to submitted claims, to Nebraska Medicaid or the member’s health plan.
Implementation of Individual Ex Parte
Arizona renewed 82% of members up for renewal in December through ex parte. The Arizona Health Care Cost Containment System (AHCCCS) highlighted the ex parte rate in a press release announcing AHCCCS has maintained coverage for 1.4 million enrollees since the state began unwinding the continuous coverage requirement.
Outreach Partnerships With Other Stakeholders
New Jersey regional health hubs are supporting redeterminations. The Camden Coalition, one of New Jersey’s four regional health hubs, is playing a key role, along with its partners throughout South Jersey, to ensure community members don’t lose access to healthcare coverage. The Coalition is conducting direct telephonic outreach to enrollees in South Jersey who have not returned their paperwork and is training their Community Ambassadors in how to talk to residents about Medicaid redetermination. Ambassadors are also providing feedback to the Department of Human Services on community perceptions and experiences of the redetermination process.
Pennsylvania announced it will survey enrollees about their redetermination experiences. Department of Human Services Secretary Dr. Val Arkoosh announced the launch of a survey to collect feedback from Medicaid enrollees about their experience completing their annual renewal. The survey is being conducted in partnership with the University of Pittsburgh’s Medicaid Research Center, and feedback collected will be used to inform renewal outreach strategies moving forward. Participants will be contacted via text message.
Medicaid and Marketplace Communication and Outreach Efforts
Arizona spotlights effective communication strategies and tools implemented during unwinding. The Arizona Health Care Cost Containment System (AHCCCS) published a video highlighting effective tools and strategies employed in support of Arizona’s renewal effort. The video features: the AHCCCS Connect text/email/phone messaging that follows members through their Medicaid lifecycle; an English and Spanish language surge call center; SAM, a chatbot that answers more than 80 renewal questions and can change a member’s contact information directly in the chat, and which earned a 95% satisfaction rating from members; and the addition of a QR code on renewal packets that automatically triggers electronic member contact and the ability to update one’s address via text link.
Maryland rebranded their unwinding campaign for 2024. The Maryland Department of Health revised their Medicaid unwinding campaign to update it for the current calendar year: it is now the “Medicaid 2024 Check-In Campaign.”
New Hampshire hosted a discussion of the Medicare special enrollment period. The New Hampshire Department of Health and Human Services posted a recording of an information session about the Medicare special enrollment period (SEP) which allows an individual to sign up for Medicare without incurring a late enrollment penalty. Individuals 65 or older who are no longer eligible for Medicaid can participate in the SEP.
Nevada is reminding members that it is restarting terminations for not returning paperwork. Nevada Medicaid issued a reminder to members to update their address and complete the renewal packet they receive in the mail since Medicaid disenrollments for members who do not complete the required paperwork restart January 1, 2024.
Making Information About Unwinding Public
Arizona has completed redeterminations of their COVID-protected group. AHCCCS announced it met the requirements of a state statute to redetermine Medicaid eligibility for members who had maintained coverage during the pandemic. For the duration of the Medicaid continuous coverage requirement, AHCCCS continued its renewal process and was able to estimate that approximately 675,000 individuals were no longer eligible, referred to as the “COVID Override group.” Within this group, members who were ineligible due to their income represented about half of the total and were prioritized for eligibility redetermination when regular renewal procedures began in April 2023.
Kentucky published unwinding data for November. The Kentucky Cabinet for Health and Family Services released an unwinding demographic report for November. A total of 22,888 individuals who had their renewal due on November 30 were determined eligible for renewed coverage. 1,492 individuals were determined ineligible based on eligibility requirements and were terminated. For individuals who were procedurally terminated on November 30 and have supplied requested information, 849 renewals were reinstated.
Maryland released November unwinding data. The Maryland Department of Health announced the release of Medicaid renewal data for November 2023. The release marks the halfway point of Medicaid renewals, which are set to conclude in April 2024. Through November 2023, Maryland Medicaid processed more than 923,000 individuals’ renewals. Among these, 71% of enrollees were determined eligible to have their coverage extended. Of this number, 102,471 participants were determined eligible due to active enrollment in the Department of Human Services’ Supplemental Nutrition Assistance Program (SNAP). 11% were disenrolled for procedural reasons, such as not updating eligibility information, and 9% were determined to be not eligible based on information provided and were disenrolled.
Michigan’s renewal rate for October was over 70%. The Michigan Department of Health and Human Services (MDHHS) announced it renewed Medicaid coverage for nearly 1 million people in 2023, including 143,025 whose eligibility was up for renewal in November. There were 11,191 people disenrolled in November because they were no longer eligible and 2,025 whose eligibility was not renewed for procedural reasons. MDHHS also announced that the renewal rate for Medicaid enrollees whose eligibility was being redetermined for October was just over 70%, the first time that the monthly renewal rate has exceeded 70%.
New York published an unwinding report for November. The New York State Department of Health released the sixth issue of New York’s Public Health Emergency Unwind Dashboard, a monthly enrollment report reflecting data on renewal status, demographics, and program transitions for enrollees with Medicaid, Child Health Plus, and the Essential Plan. This issue of the Unwind Dashboard provides a point-in-time snapshot for individuals who had a November 30, 2023 coverage end date, following the sixth wave of eligibility redeterminations for these safety net programs.
Oregon released unwinding data through mid-December. The Oregon Health Authority (OHA) announced 1,053,636 people have completed the Medicaid renewal process as of December 12. This represents 72.4% of all OHP and Medicaid members. 898,868 people (85.3%) were renewed and kept their benefits while 140,535 people (13%) were found ineligible. In December, renewal letters were sent to an additional 143,808 people. 73.6% were renewed without any action needed, 21.4% were asked to provide some information, 2.4% were asked to complete a renewal form, and 2.9% had previously reported that they no longer met income limits or other requirements and received a notice that their benefits would end in 60 days.