States of Unwinding: July 7, 2023
With the exception of Oregon, all states have begun terminating enrollees no longer eligible for coverage and the unwinding of the Medicaid continuous coverage requirement is now being operationalized across the United States.
Communications and outreach is a key focus across the 49 states, with states who have been processing renewals since April adding new features to their outreach strategies and states who are just starting terminations this month, like New York, employing prominent messengers to get the word out about renewals. States are coordinating outreach across agencies, as Nevada highlighted, and also partnering with stakeholders–Texas is co-hosting in-person events with food banks and West Virginia created a search tool individuals can use to find a community partner to support their renewal. States that operate their own Marketplaces are ramping up their communications efforts as well and providing information and resources for employers.
As more states have begun processing redeterminations they are also publishing data. Vermont launched a dashboard, and State Health and Value Strategies updated our expert perspective State Reporting to Monitor the Unwinding of the Medicaid Continuous Coverage Requirement to reflect the latest states reporting data publicly. Massachusetts and Pennsylvania announced the number of individuals no longer eligible for Medicaid who enrolled in coverage through each state’s Marketplace.
Lastly, Minnesota announced it is leveraging the new federal flexibilities released by CMS to minimize the loss of coverage for procedural reasons. As a reminder, SHVS has created a one-stop resource page to support states as they plan for and implement unwinding.
Employing Prominent Messengers
New York’s governor is encouraging eligible New Yorkers to renew their health insurance coverage. Kathy Hochul, the state’s governor, issued a public service announcement to get the message out to New Yorkers. In the video, Governor Hochul encourages New Yorkers to take action to renew their coverage.
Coordinating Unwinding Communications and Outreach
Nevada highlighted how state agencies and the Marketplace are working together. NevadaHealth Link, the state’s official health insurance Marketplace, Nevada Medicaid and the Division of Welfare and Supportive Services (DWSS) issued a press release about how the state agencies are working to keep Nevadans insured by encouraging them to fill out their redetermination packets in the mail and if they are no longer eligible for Medicaid, to seek affordable health insurance coverage through Nevada Health Link. As the renewal process continues to unwind over the next 12 months and the transfer of accounts from Medicaid to the Marketplace increases, Nevada Health Link underscored it will continue working with Nevada Medicaid and DWSS to reach Nevadans who no longer qualify for Medicaid coverage and help them obtain coverage.
Medicaid Communication and Outreach Efforts
Arizona has created a live chat feature to answer enrollees’ questions about renewals. The Arizona Health Care Cost Containment System announced two new tools to help enrolled Medicaid members complete their annual Medicaid renewal: live chat and automated phone calls to any individual whose renewal mail is returned. The new live chat feature is available during business hours to help enrolled members who have questions about their annual Medicaid renewal process. After hours, the chatbot SAM can answer more than 40 common questions about the renewal process.
New York announced a public education campaign. The New York State Department of Health is promoting Medicaid unwinding through targeted outreach activities, including a public education campaign and close partnership with healthcare providers to ensure they are equipped to help consumers through the process.
Rhode Island announced it sent out renewal letters for July. The Executive Office of Health and Human Services (EOHHS) announced that July renewal letters have been sent. EOHHS is asking enrollees to please return requested information within 30 days of the date on their yellow notice. In their announcement, EOHHS highlighted that some Medicaid members may have had their renewal date changed. While an original estimated Medicaid renewal date may be changed to a later date, it will never be changed to sooner than projected. To view their estimated renewal date, enrollees can login to their account on HealthyRhode.RI.gov.
Washington is mailing Medicaid enrollees reminder postcards. The Washington State Health Care Authority (HCA) has begun mailing postcards to Medicaid members to remind them that keeping their information up to date is crucial to receive communication about their Medicaid coverage. HCA also published updated frequently asked questions on the unwinding of continuous coverage.
Marketplace Communication and Outreach Efforts
Connecticut’s Marketplace is hosting four in-person enrollment fairs. Access Health CT, the state’s official health insurance Marketplace, announced it will host four free, in-person enrollment fairs in July and August to assist former Medicaid enrollees who are no longer eligible for Medicaid. Former Medicaid enrollees who need assistance with the process of enrolling in a Marketplace plan or have questions can get help from an Enrollment Specialist at the enrollment fairs.
Idaho’s Marketplace extended its special enrollment period to 90 days for individuals no longer eligible for Medicaid. Your Health Idaho, the state’s official health insurance Marketplace, updated its list of frequently asked questions to inform individuals that the state’s special enrollment period for loss of Medicaid coverage has been extended from 60 to 90 days after the date an individual loses Medicaid coverage.
Massachusetts’ Marketplace has a form employers can use to submit questions about the renewal process. The Massachusetts Health Connector, the state’s official health insurance Marketplace, added to its unwinding resources for employers and employees a form Massachusetts employers can use to submit questions about redeterminations.
New York’s Marketplace created a webpage for employers about unwinding. New York State of Health’s webpage includes information for employers that offer insurance coverage to their employees and where to direct employees if employer-sponsored coverage is not offered. Resources include a fact sheet for employees, frequently asked questions for employers and a letter to employers on redeterminations and coverage.
Outreach Partnerships With Other Stakeholders
Oklahoma is working with Unite Us to support individuals no longer eligible for Medicaid. The Oklahoma Health Care Authority and Unite Us have partnered to help SoonerCare members who may no longer be eligible for Medicaid. Unite Oklahoma is a coordinated partnership between community-based organizations, healthcare providers, and government agencies. Individuals no longer eligible for Medicaid can submit a form through Unite Us to access assistance in finding alternative forms of coverage and other supportive services.
Pennsylvania continues to partner with federally qualified health centers. Pennsylvania Department of Human Services Secretary Dr. Val Arkoosh and Pennie Executive Director Devon Trolley joined representatives from Philadelphia FIGHT to highlight how the Shapiro administration and local health centers are collaborating to support Pennsylvanians during unwinding so they can complete their renewals, protect their health, and stay covered. Philadelphia FIGHT is a Federally Qualified Health Center, founded in 1991 as a clinical research organization working toward a cure for AIDS. Since that time, the organization has grown to encompass primary care for close to 8,000 people.
Texas is partnering with food banks to host in-person assistance events. To help with increased Medicaid renewals due to the end of continuous Medicaid coverage, the Texas Health and Human Services Commission (HHSC) is hosting community events in select Texas cities. HHSC’s Community Partner Program, in partnership with Feeding Texas and local food banks, is hosting events in four cities in July and August to enable enrollees to access assistance with renewing their enrollment. Community Partners and HHSC team members will be available at the events.
West Virginia has a search tool individuals can use to locate a community partner to help them with renewals. The West Virginia Bureau of Medical Services announced that help is available in submitting renewals and applications. Renewals and applications may be submitted online with the assistance of a Community Partner. This is an agency or organization that assists individuals and families with completing renewals or applying for Medicaid or CHIP. A search tool is available to locate a community partner by county.
Making Information About Unwinding Public
Colorado is comparing its first month of data on unwinding redeterminations to pre-pandemic data to contextualize the numbers. Colorado’s data from the first cohort of enrollees to be renewed shows similar renewal rates compared to pre-pandemic levels. To better understand the first month’s data the Department of Health Care Policy & Financing (HCPF) compared results for enrollees whose renewals were due at the end of May to 2018-2019 numbers: in close alignment with 2018-2019, 56% of those with May renewal anniversaries maintained coverage. Of those, HCPF automatically renewed 43% through ex parte, while 57% renewed after completing their renewal packet. Of the 42% disenrolled, 16% (or almost 20,000) no longer qualify due to exceeding the income levels for their household size or eligibility classification. Twenty-six percent (about 30,000) of those with May renewal anniversaries lost eligibility for procedural reasons such as not completing the renewal paperwork submission process. That figure was 12% prior to the pandemic.
Massachusetts’ Marketplace shared data on the number of individuals no longer eligible for Medicaid who enrolled in coverage. The Massachusetts Health Connector, the state’s official health insurance Marketplace, shared an update on Medicaid redeterminations and transitions to the Health Connector during a June 8 board of directors meeting. As of June 5, a total of 34,645 individuals were found eligible for Marketplace coverage and 7,997 individuals, or 23%, enrolled in a plan.
Nevada’s Marketplace issued a press release about the number of individuals transferred to the Marketplace. During the months of April and May, 94% of those who applied for health coverage after being transferred to the Marketplace from Medicaid were found eligible to enroll, and 74% of those who applied were additionally found eligible for financial assistance. Nevada Health Link will begin sharing a regular set of data points that will provide a snapshot of ongoing redeterminations and enrollments over the coming months.
Oklahoma published a fact sheet summarizing unwinding data for May. The Oklahoma Health Care Authority posted a Fast Facts sheet on Medicaid unwinding for the month of May, which includes data on disenrollments, including procedural disenrollments and appeals.
Pennsylvania’s Marketplace reported the number of individuals who enrolled in coverage in May through the state’s special enrollment period for unwinding. Pennie, Pennsylvania’s official health insurance Marketplace, reported during a May 31 board of directors meeting that a total of 33,346 individuals began a Marketplace application through the loss of Medicaid special enrollment period and 3,178 individuals, or 10% enrolled in a plan.
Vermont created a dashboard to track unwinding. The Department of Vermont Health Access published a Medicaid renewal dashboard that will be updated monthly. The dashboard highlights the number of Medicaid cases that have been renewed or are pending renewal and data on members whose Medicaid coverage has been terminated due to eligibility for administrative reasons.
Washington published data for its first month of renewals. HCA, in partnership with the Washington Health Benefit Exchange and the Department of Social and Health Services, released initial data from May 2023, the first month of Medicaid renewals for the state. Roughly 116,000 people were disenrolled from coverage due to various reasons.
Leveraging Federal Flexibilities and Improving Processes
Minnesota is making use of one of the new CMS strategies announced by Secretary Becerra in recent weeks. The Minnesota Department of Human Services announced it will extend the deadline to renew Medicaid for 35,500 people whose renewal paperwork is overdue for July 1 coverage. The state is working with the federal government to avoid ending coverage for people who may still qualify, but face barriers such as not receiving the form in the mail.