States of Unwinding: October 17, 2023
In the first half of October, additional states paused procedural terminations and reinstated coverage as they implemented mitigation strategies to address the system issues related to conducting ex parte at the individual level. For example, Alaska paused disenrollments and New York reinstated affected individuals while Wyoming announced it has implemented individual ex parte reviews and Colorado will have system fixes in place to do so as of mid-October.
In an effort to ensure eligible individuals maintain their coverage, several states are leveraging federal flexibilities to extend the amount of time Medicaid enrollees have to return renewal forms, such as New Mexico and Texas. Other states, such as California and Minnesota, have implemented federal flexibilities to streamline the application process.
States continue to outreach and communicate to enrollees about the unwinding, including alerting consumers about scams. Louisiana announced it is partnering with pharmacies to outreach to enrollees and support their renewals and South Carolina released several how-to videos that provide instructions for completing and submitting renewal paperwork.
As unwinding progresses, 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
Alaska is pausing disenrollments. The Alaska Department of Health is temporarily pausing Medicaid disenrollments to assess whether individuals were inappropriately disenrolled due to the individual ex parte issue, according to Deb Etheridge, Director of the state’s Division of Public Assistance. Over the past three weeks, the department has re-enrolled more than 400 children and 200 adults who were previously disenrolled, Etheridge said. The pause will continue until the department can review the paperwork for all of the families that were disenrolled since unwinding of the continuous coverage requirement in Alaska started in May.
New York reinstated 68,000 people. The New York Department of Health released its Public Health Emergency Unwind Dashboard tracking August renewal data. As a result of the federal directive that a person’s eligibility must be determined at the individual level rather than the household level, New York reinstated approximately 68,000 people who lost coverage in June, July and August. The renewal rate increased from 82% to 92% for children under age 19 and from 70% to 72% for adults 19 and older. Individuals who were reinstated will have their coverage extended for 12 months, and this will continue as a monthly process while the state’s contractor works toward a permanent system solution. Consumers are being provided notice of how to get outstanding medical bills paid for or reimbursement for any paid medical bills during the period without coverage.
Implementation of Individual Ex Parte
Colorado will begin conducting individual ex parte reviews in October. The Colorado Department of Health Care Policy and Financing announced it will begin conducting ex parte renewals at the individual level as of October 2023 and added an additional list of frequently asked questions (FAQs) about the ex parte temporary extensions and reinstatements to the PHE Unwind FAQs Renewals Category.
Wyoming saw a decrease in the number of individuals losing coverage in part due to implementing individual ex parte reviews. As of September 30, according to a spokesperson for the Wyoming Department of Health, Medicaid and Kid Care CHIP benefits for about 9,000 people had been terminated since the state began redeterminations. This is a decrease from the previous total of 10,700 individuals who had been terminated as of July. The change in the overall number of individuals losing coverage is the result of individuals responding to renewal requests as well as the implementation of ex parte reviews at the individual level.
Leveraging Federal Flexibilities
California received approval from CMS to implement additional flexibilities. CMS approved the Department of Health Care Services’ (DHCS) request for two flexibilities that leverage existing regulations to help streamline the processing of annual Medi-Cal eligibility renewals and ease burdens on county program administrators and Medi-Cal members. The first flexibility waives the requirement for Medi-Cal members to sign and return a renewal packet that had already been submitted if counties receive verification of missing information after the packet was mailed. The second flexibility allows the use of the explanation submitted by the member within the renewal packet as sufficient verification for a successful redetermination, eliminating the need for additional supporting documentation. The flexibilities will continue throughout the unwinding period. DHCS issued a Medi-Cal Eligibility Division Information Letter to provide counties with immediate guidance on operationalizing these flexibilities.
Kentucky is tracking the federal flexibilities it has implemented during unwinding. The Kentucky Cabinet for Health and Family Services updated their table tracking the flexibilities the state has leveraged during the unwinding, which includes flexibilities that have been implemented to ensure streamlined Medicaid renewals, flexibilities that have been implemented permanently, and flexibilities that are no longer in effect.
Minnesota is simplifying the renewal process by leveraging federal flexibilities. The Minnesota Department of Human Services (DHS) announced a simplified renewal process for certain Medicaid and MinnesotaCare enrollees. DHS previously implemented the CMS flexibility allowing information from the Supplemental Nutrition Assistance Program (SNAP), Temporary Assistance for Needy Families (TANF) and Tribal TANF to auto renew healthcare enrollees for people age 65 or older, who are blind or have a disability for August 2023 renewals. DHS will expand this strategy to auto renew families with children, adults without children and MinnesotaCare, beginning with January 2024 renewals.
New Mexico is providing an additional 30 days to submit renewal forms and requesting additional flexibilities from CMS. The New Mexico Human Services Department (HSD) announced the agency is providing an additional 30 days for Medicaid enrollees to submit their renewal applications. HSD also requested and was granted CMS approval for a flexibility to allow New Mexicans whose income is at or below 100% of the federal poverty level to automatically renew their Medicaid coverage for 12 months without requesting additional information or documentation. The agency is also seeking CMS approval for an additional strategy to mitigate loss of coverage at renewal for children ages zero to six.
Texas is extending the deadline for certain Medicaid enrollees to return their renewal forms. The Texas Health and Human Services Commission (HHSC) is providing certain Medicaid enrollees an additional 30 days to complete their renewal packets. Medicaid enrollees who are eligible to receive additional time to complete their renewals were notified on or around October 10 via mail or through their Your Texas Benefits account. Individuals who receive this additional time are most likely to remain eligible for Medicaid coverage, such as older adults and people with disabilities. HHSC is also focused on a targeted outreach campaign for Medicaid’s intellectually and developmentally disabled populations, school-aged children and the aging community.
Alerting Consumers About Scams
Minnesota is collaborating across agencies to warn consumers about Medicaid scams. Minnesota Department of Commerce and MNsure, the state’s official health insurance Marketplace, issued a joint public service announcement alerting consumers to be aware of scams targeting Minnesotans who are no longer eligible for Medicaid. In some cases, scammers have taken money from consumers by saying they must pay for help enrolling in a plan or asking them to pay for premiums up front over the phone.
Pennsylvania is alerting Medicaid enrollees to be wary of scams. The Department of Human Services (DHS) is informing Pennsylvanians of a potential scam targeting individuals who receive Medicaid wherein a scammer implies that an individual’s healthcare coverage is in jeopardy and asks for their personal payment information to continue their coverage. The press release includes examples of the scam and directs anyone who has received a suspicious call or text to contact the DHS fraud tip line.
Medicaid Communication and Outreach Efforts
Louisiana is working with pharmacies to support renewals. The Louisiana Medicaid Pharmacy Outreach Project is a Medicaid unwinding initiative in which independent pharmacies provide outreach and assistance to patients and customers. The goal is to assure that at the conclusion of the project (May 31, 2024), Medicaid members have not lost their Medicaid health coverage for failure to complete the eligibility renewal process. Independent pharmacy partners can receive compensation and outreach materials at no cost, as well as technical assistance.
Nebraska is hosting a Medicaid listening tour to share updates on unwinding. The Nebraska Department of Health and Human Services Division of Medicaid and Long-Term Care will host the next Medicaid listening tour throughout October and November 2023 in communities around the state. During the listening tour—which will include 12 meetings in 10 cities throughout Nebraska, along with two virtual sessions—Nebraska Medicaid will be announcing upcoming changes to the program and providing updates on the continuous coverage unwind.
Rhode Island added a feature that allows enrollees to access information about their renewals. The Rhode Island Department of Human Services announced new automated options for Medicaid enrollees to access renewal information specific to their case when contacting the call center.
South Carolina released how-to videos to support renewals. The South Carolina Department of Health and Human Services released three instructional videos designed to help Medicaid members complete their annual eligibility reviews. Medicaid members can complete their annual eligibility review, check their annual review status, update their contact information and submit required documents online at apply.scdhhs.gov. The videos walk Medicaid members through the steps to create an online account, complete their eligibility review and other tasks.
Making Information About Unwinding Public
Arizona announced it is half way through eligibility redeterminations. The Arizona Health Care Cost Containment System (AHCCCS) released its monthly Medicaid renewal data dashboard. AHCCCS is at the midpoint of the process to renew all 2.5 million enrolled members, and more than one million individuals have maintained their Medicaid coverage. Of the renewals initiated in September, 84% of members maintained coverage and 73% of those renewals were automatically determined without the need for members to take action.
Arkansas announced it has completed Medicaid eligibility redeterminations. The Arkansas Department of Human Services issued a press release stating it has completed Medicaid eligibility redeterminations for individuals enrolled as a result of the continuous coverage requirement. In September, more than 45,000 individuals’ cases were renewed after eligibility was confirmed, and 53,553 individuals were disenrolled.
Maine released updated unwinding data and highlighted it is still pausing procedural terminations. The Maine Department of Health and Human Services (DHHS) released updated data on the resumption of Medicaid eligibility reviews. This update of August 2023 data is available on the MaineCare Renewals Data Dashboard. Over 53,000 Medicaid members had their coverage successfully renewed over this four-month period, including over 7,500 who were renewed through the ex parte renewal process for the first time in August 2023. DHHS continues to refrain from disenrolling members for the procedural reason of not returning their renewal form to prevent individuals and families from losing coverage unnecessarily as it works to improve its ex parte system.
Oregon provided an update on renewals to date. The Oregon Health Authority announced its latest Medicaid renewal data, which shows that of the individuals who have come up for renewal since April, 419,663 people were fully renewed; 39,610 individuals were found ineligible; 11,027 members had a reduction in benefits; and 48,859 are processing. The state is currently awaiting responses from 23,994 members.
Washington released data on enrollment in Marketplace coverage among individuals no longer eligible for Medicaid. The Washington Health Benefit Exchange released a data snapshot which shows affordable health plans are proving critical to keeping people covered and advancing equity during the Medicaid unwind. The data snapshot indicates that the percentage of eligible consumers selecting a qualified health plan (QHP) after their Medicaid coverage ended increased to 27% from 17% pre-pandemic; 24,000 residents selected a QHP—doubling pre-pandemic selections; there is higher uptake among consumers who are younger, Hispanic, and non-White; and Cascade Care and federal subsidies are helping 87% of former Medicaid enrollees afford high-quality plans.