States of Unwinding: September 28, 2023
As states look to address the system issues related to conducting ex parte at the individual level, Colorado is implementing a temporary extension of all members up for renewal in September and October while Maryland noted it paused procedural terminations of individuals in August. Nevada reinstated coverage for affected individuals, as did New Hampshire and Wisconsin. To reduce the number of individuals terminated for procedural reasons, states such as Georgia and Vermont continue to leverage federal flexibilities.
States continue to innovate in their efforts to outreach to and communicate with enrollees. In New York, enrollment assisters attended back-to-school events and Maine is partnering with community-based organizations to connect consumers with assistance to complete their renewals. Medicaid communication and outreach efforts also include hosting webinars and virtual stakeholder meetings, which states such as Indiana and Kentucky are using to highlight new resources or specific initiatives. State Marketplace communication and outreach efforts include several states making outbound calls to individuals no longer eligible for Medicaid, hosting enrollment fairs and reminding consumers about their state’s special enrollment period.
In an effort to preserve coverage for medically fragile enrollees, Michigan is extending the renewal date of individuals receiving life-saving treatments until May 2024.
Lastly, states continue to make information about unwinding public. State Health and Value Strategies continues to track states that are making their unwinding data public through our expert perspective, which includes an interactive map. SHVS 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
Colorado is temporarily extending all members up for renewal in September and October while it implements systems changes to conduct ex parte at the individual level. The Department of Health Care Policy and Financing (HCPF) announced that in response to guidance from CMS regarding conducting ex parte at the individual level, it is implementing a temporary renewal extension for all members up for renewal in September and October. By mid-October HCPF plans to implement a short-term system change that will bring the state into compliance with the ex parte guidance, with a longer-term solution requiring more extensive revisions to the state’s eligibility system. HCPF is also developing a strategy to renew coverage for members who were disenrolled.
Maryland paused procedural terminations in August. Maryland noted in the publication of their August unwinding data that they paused procedural terminations of Medicaid participants for the month of August in response to the State Medicaid Director Letter published by CMS.
Nevada reinstated coverage for 114,000 individuals. The Department of Health and Human Services announced the reinstatement of Medicaid coverage for Nevadans who recently had their coverage end because they did not return their renewal documentation. The Division of Welfare and Supportive Services reinstated coverage for approximately 114,000 individuals.
New Hampshire reinstated 3,176 people. According to the state’s Medicaid Director Henry Lipman, the 3,176 people reinstated represent about 2.8% of the more than 113,000 eligibility redeterminations New Hampshire has completed since April 1. New Hampshire will also cover the Medicaid-eligible medical bills the enrollees who will be reinstated incurred while they did not have coverage.
Wisconsin is reinstating about 4,000 individuals. In Wisconsin the roughly 4,000 enrollees will have their coverage reinstated by the end of October, according to a spokesperson for the Department of Health Services, and it will be retroactive to the date when they were terminated. Wisconsin members will receive a notice explaining their reinstatement and how they can obtain coverage of unpaid medical bills.
Leveraging Federal Flexibilities
Colorado is extending the renewal period for enrollees receiving long-term care. HCPF is leveraging guidance from CMS to extend the renewal period for enrollees receiving long-term care (LTC) and waivered services and have not returned their renewal packet. Instead of the 30-day delay CMS recommended, Colorado will be extending the renewal time frame for LTC members by 60 calendar days to allow for additional outreach and action on the renewal. This allows LTC members to have an additional 60 calendar days to return their packet or for it to be processed by the county for cases that are past due.
Georgia received approval for seven waivers related to unwinding. The Georgia Department of Community Health announced that it has received federal approval to use seven waivers to help streamline the Medicaid unwinding process.
Vermont is delaying procedural terminations for one month. The Department of Vermont Health Access announced that members who did not respond to their August renewal deadline due to flooding in the state will continue their enrollment in Medicaid for another month and the deadline for those members to return their paperwork will be moved to September. The state had previously extended coverage for individuals impacted by the flooding in July by extending benefits through August.
Back to School Communication and Outreach Campaigns
New York enrollment assisters attended back-to-school events. NY State of Health enrollment assisters attended back-to-school community events across the state to answer questions about the Marketplace and navigating the Medicaid renewal process. NY State of Health also announced the availability of its back-to-school online toolkit, a resource with informational materials and messaging to educate New Yorkers about the importance of health insurance during the upcoming school year.
Connecting Consumers With Assistance
Maine is working with community-based organizations to provide enrollees with extra help. The Maine Department of Health and Human Services (DHHS) is partnering with local community-based organizations (CBOs) across the state to help individuals with the unwinding process. The organizations provide culturally relevant outreach and education to minimize unnecessary coverage loss and facilitate transitions to the Marketplace. The CBO partners are available to explain the unwinding process and answer questions; help individuals complete their reenrollment forms; and assist those no longer eligible for Medicaid to find other options. DHHS has listed on their unwinding page the CBOs the state is partnering with.
Medicaid Communication and Outreach Efforts
Indiana hosted a stakeholder meeting during which they promoted a new flier. The meeting hosted on September 21 highlighted a new flier that outlines steps for members if they have lost coverage. The flier includes a QR code that enrollees can use to search for providers who accept presumptive eligibility if an individual needs emergency care. The flier also includes a reminder that children’s income eligibility differs from that of their parents and encourages individuals who have lost coverage to check with their employers to see if they are eligible for employer-sponsored coverage.
Kentucky’s stakeholder meeting highlighted how providers are supporting patient renewals. The Kentucky Cabinet for Health and Family Services posted the slides and recording of the August stakeholder meeting on unwinding. During the meeting, officials shared data on the number of Medicaid reinstatements as of the end of August; how providers are supporting patients through renewals; new outreach fliers also available in Spanish; and flexibilities the state has implemented during the unwinding.
New York hosted a webinar for members on renewing coverage. The New York Department of Health hosted a member webinar that reviewed the timeline for renewal and what members need to do to keep their Medicaid coverage. New York has developed infographics that profile the renewal process for each of the state’s three eligibility systems and the webinar provided a walkthrough of the renewal packets for each eligibility system so members know what to look for in the mail.
Marketplace Communication and Outreach Efforts
California is calling individuals who have been automatically enrolled in Marketplace coverage. Covered California is piloting an outbound call campaign during the unwinding to Medicaid transitioners who have received an automatic plan selection. The campaign launched in late August and will target consumers who have received a $0 premium plan with an August 1 start date. Service center representatives will offer assistance with understanding coverage eligibility, opting into coverage and plan choice. The effectiveness of the outbound call campaign will be evaluated on effectuation rates.
Connecticut’s Marketplace is hosting in-person enrollment fairs. Access Health CT (AHCT) announced free events to help eligible Connecticut residents enroll in HUSKY Health, the state’s Medicaid program, and qualified health plans. AHCT will host free, in-person enrollment fairs in September and October at public libraries and community centers across the state. Additionally, the Health, Equity and Outreach team at AHCT is working directly in the community and hosting monthly Zoom meetings for anyone who wants to learn more about enrolling in coverage through AHCT. These interactive meetings, called “Healthy Chats” allow consumers to ask questions about financial help, issues related to coverage, and Medicaid renewals. If the AHCT representative cannot answer a question, they will get back to the consumer over the phone.
Idaho is encouraging those no longer eligible for Medicaid to take advantage of a special enrollment period. Your Health Idaho is informing Idahoans who have lost Medicaid coverage that they have until November 30, 2023, to enroll in Marketplace coverage through an extended special enrollment period (SEP). The SEP for the loss of Medicaid coverage has been extended for any Idahoan who lost their Medicaid coverage during the unwinding. Idahoans whose 90-day SEP has ended or Idahoans still within their 90-day SEP all have until November 30 to enroll in coverage.
Nevada is making outbound calls to individuals no longer eligible for Medicaid. Nevada Health Link has implemented enhancements to its Marketplace portal and has conducted extensive outreach to thousands of individuals whose information was transferred from Nevada Medicaid. This effort included over 6,500 outbound calls to Nevadans who have been notified that they are no longer eligible for Medicaid, to provide assistance with next steps for getting enrolled in an affordable qualified health insurance plan. In July, the state saw a 50% increase in the number of individuals who submitted a Marketplace enrollment application after losing Medicaid or CHIP.
Preserving Coverage for Medically-Fragile Enrollees
Michigan is extending coverage for individuals undergoing life-saving treatments. The Michigan Department of Health and Human Services is extending the renewal of enrollees undergoing life-saving treatment through May 2024 to ensure these enrollees can keep their healthcare coverage and complete their treatment. The extension for those receiving life-saving treatment applies to enrollees undergoing chemotherapy, radiation, immunotherapy infusions or dialysis who are not able to be renewed through ex parte and do not have other comprehensive health insurance coverage, like Medicare.
Making Information About Unwinding Public
Arizona’s August data release notes the state is conducting ex parte renewals at the individual level. The Arizona Health Care Cost Containment System (AHCCCS) released its fourth monthly Medicaid renewal data dashboard detailing progress since the regular renewal process began on April 1, 2023. The press release notes AHCCCS is conducting ex parte at the individual level.
California is now publishing demographic data for all redetermination measures. The California Department of Health Care Services (DHCS) published on Friday, September 8 the July 2023 Medi-Cal continuous coverage unwinding eligibility measures data on the Medi-Cal Enrollment and Renewal Data webpage. The July dashboard includes data on Medi-Cal enrollment, applications in progress, redeterminations, and disenrollments. For the first time, this data set includes demographic details for all redetermination measures, along with the top reasons for disenrollments. In July, there were just over a million redeterminations due. Nearly 50% of these redeterminations were pending at the end of the month while 43% of cases were renewed (27% via ex parte) and 7% were disenrolled. The top three disenrollment reasons were 1) procedural/administrative issues; 2) other reasons (e.g., member location unknown, enrolled in Supplemental Security Income); and 3) excess income.
Colorado’s Marketplace published data on their outreach efforts to individuals no longer eligible for Medicaid. Connect for Health Colorado released an update on coverage transition data from Medicaid to the Marketplace during the months of May through August. The data includes total emails sent and total calls made to individuals who were determined no longer eligible for Medicaid and individual enrollments.
Idaho has completed renewals for the COVID-19 protected group. The Idaho Department of Health and Welfare (DHW) announced it has completed its reevaluation of Idaho Medicaid enrollees whose benefits were protected under federal law during the COVID-19 pandemic. In all, DHW staff processed renewals for 153,196 individuals of whom 31,900 were determined eligible and 121,296 were ineligible. Of those who were determined ineligible, 30% obtained coverage through the state’s health insurance Marketplace.
Massachusetts. The Massachusetts Health Connector released an enrollment summary for the unwinding period to date. The report includes total enrollment in the Health Connector broken down by subsidized and unsubsidized coverage; the prior eligibility status of newly enrolled members; a summary of plan selections; a summary of those who are eligible but not enrolled; and a contact center summary.