States of Unwinding: November 10, 2023

As states continue to implement systems changes to enable ex parte reviews at the individual level, Maryland announced it was pausing procedural terminations in October, while Minnesota announced it was reinstating coverage for affected individuals. Alaska published the mitigation strategies it is implementing to facilitate individual level ex parte reviews. States also continue to make use of federal flexibilities to streamline unwinding eligibility and enrollment processes, with Colorado receiving approval to continue coverage for individuals while they appeal decisions related to their eligibility and benefits and the District of Columbia providing additional time for enrollees to return renewal forms. 

Recent Medicaid outreach and communications efforts have been focused on children. California and Maryland released communications materials for school partners, while Nebraska is reminding parents that their children may still be eligible. State-Based Marketplace communication efforts include developing specific materials for this open enrollment period, as in Idaho, and Massachusetts hosted a webinar for the Brazilian Portuguese population. 

Lastly, states continue to update their data dashboards and make information about unwinding public. 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. As a reminder, SHVS has created a one-stop resource page to support states as they plan for and implement unwinding.  

Pausing Procedural Terminations and Coverage Reinstatements

Maryland paused procedural disenrollments for the month of October. The Department of Health, in a written statement to the news outlet Maryland Matters, announced that it was pausing procedural terminations for enrollees in October: “Procedural disenrollments are paused and will resume in November, and reflected in our December data report. This is because the system changes to conduct ex parte (automatic) have been facilitated to begin the renewals at the individual level at that time.” 

Minnesota reinstated coverage for 12,745 individuals. Minnesota is restoring health insurance coverage for 12,745 residents, including many children, as the state revisits eligibility for Medicaid enrollees. The state has implemented fixes to restore coverage and prevent a recurrence of the problem going forward, said Jodi Harpstead, the Minnesota Department of Human Services commissioner.

Implementation of Individual Ex Parte

Alaska published the mitigation strategies it is implementing to address issues with individual ex parte. The Alaska Department of Health published an updated list of its mitigation and enhancement strategies for unwinding. As a reminder, the Centers for Medicare & Medicaid Services (CMS) also recently published an interactive map and updated table of the section 1902(e)(14) waivers approved for states and territories to facilitate unwinding, including strategies to support ex parte processes. 

Leveraging Federal Flexibilities 

Colorado received approval from CMS to implement an appeals process during unwinding. The Department of Health Care Policy and Financing (HCPF) recently received approval by CMS of a 1902(e)(14) waiver which will allow members who file an appeal within the 60-day deadline to receive continued benefits regardless of the termination date and will have benefits reinstated back to the closure date. This appeals strategy will apply to all appeals, not just eligibility. HCPF also announced a 60-calendar-day extension to complete the renewal process for specific populations, including long-term care members on waivered services and buy-in enrollees who have not returned their renewal packet on time during unwinding.

The District of Columbia is providing certain Medicaid enrollees an additional 30 days to return renewal forms. In response to current non-MAGI renewal rates, the Department of Health Care Finance (DHCF) will extend non-MAGI certification end dates for enrollees with November 30 end dates by an additional 30 days. During this time, DHCF will continue to work with long-term services and supports providers, case managers, managed care organization partners, and care teams to ensure that required elements of renewal submissions are submitted and requested in a timely manner. 

Medicaid Communication and Outreach Efforts

California is hosting an event for school partners. The Department of Health Care Services (DHCS) is holding a webinar titled, Keep Your Community Covered: Schools and Families. The webinar will provide school partners with important information to assist students and their families with renewing Medi-Cal coverage. During the webinar, DHCS will also highlight available outreach resources and best practices for engaging families with school age children.

Colorado is launching a new outreach campaign to address procedural denials. During the October 25 virtual meeting for stakeholders, HCPF announced it will be sending notifications by text 90 days out from an individual’s renewal date asking the member to update their contact information. HCPF is also adding outreach over the phone if the member does not return their form by the renewal date. In December the state will begin sending text messages to individuals disenrolled to remind them about the 90-day reconsideration period.

Kentucky created a “How to Reinstate Your Medicaid” flier. The state’s Medicaid program has created an informational flier on “How to Reinstate Your Medicaid” for individuals who have been terminated from Medicaid coverage and need their coverage reinstated within the 90-day period. The flier is also available in Spanish.

Louisiana is providing members with the option to update their contact information by text. The Louisiana Department of Health announced Medicaid members can now request to update their contact information through text messaging. Medicaid members can make sure that they do not miss out on important information from Medicaid by texting the words “Info” or “Information” to 72147. They will receive a text with a link to update their contact information.

Maryland released a school-based partner communications toolkit. Maryland Medicaid released new “Medicaid Check-In” partner outreach and communications materials to raise awareness of the unwinding, including school-based communications strategies and a school-based partner communications toolkit.

Nebraska is reminding parents that their children may still be eligible for Medicaid. Nebraska has added at the top of the Department of Health and Human Services (DHHS) page “Preparing To Renew Medicaid Coverage,” a call out box reminding parents that their children may still be eligible even if they have lost coverage. The call out box includes additional information of steps for parents to take and ways to contact DHHS. 

Marketplace Communication and Outreach Efforts

Idaho’s Marketplace created new toolkits for this year’s open enrollment period. Your Health Idaho, the state’s official health insurance Marketplace, has created downloadable toolkits designed specifically for open enrollment and navigating the conversation around the loss of Medicaid special enrollment period extension. The toolkits, which are also available in Spanish, are intended for community outreach, agents and brokers, and enrollment counselors. As a reminder, SHVS has created sample messages and accompanying social media graphics in English and Spanish to support states during the simultaneous Medicaid unwinding and open enrollment.

Massachusetts’ Marketplace hosted a webinar in Brazilian Portuguese on enrolling in coverage. The Massachusetts Health Connector hosted a webinar on November 2, “Keeping or Getting Coverage through MassHealth and the Health Connector,” presented in Brazilian Portuguese. The session covered how members renew MassHealth coverage, report any changes, and how to get help with completing a renewal or enrolling in Health Connector Coverage. The Connector also published a companion toolkit in Brazilian Portuguese.

Making Information About Unwinding Public

Kentucky released unwinding data for September. The Kentucky Cabinet for Health and Family Services released an unwinding demographic snapshot for September. Of the individuals who had their renewal due on September 30, 80,417 individuals had their coverage renewed. For individuals who were procedurally terminated or pending for case processing and have supplied requested information or had their case processed, 1,294 renewals have been reinstated. Of the 4,290 children terminated, 3,444 were transitioned to a qualified health plan with an advance premium tax credit.

Oregon announced it is half way through unwinding. The Oregon Health Authority (OHA) announced that as of October 19, 807,765 people have completed the Medicaid renewal process. This represents 55.6% of all Oregon Health Plan and Medicaid members, taking Oregon more than halfway through the unwinding process. In October, renewal letters were sent to an additional 137,032 people. Of these, 65.4% were renewed without any action needed; 19.4% were asked to provide some information to renew; 11.9% were asked to fill out a renewal form; and 3.4% had previously reported that they no longer met income limits or other requirements, so received a notice that their benefits will be ending in 60 days.