Medicaid Unwinding

Three weeks ago, the Centers for Medicare & Medicaid Services (CMS) announced that they were cracking down on one of the main reasons why so many people are being kicked off of Medicaid and the Children's Health Insurance Program (CHIP) even though they were still eligible: 

CMS believes that eligibility systems in a number of states are programmed incorrectly and are conducting automatic renewals at the family-level and not the individual-level, even though individuals in a family may have different eligibility requirements to qualify for Medicaid and CHIP. For example, children often have higher eligibility thresholds than their parents, making them more likely to be eligible for Medicaid or CHIP coverage even if their parents no longer qualify. This conflicts with existing federal Medicaid requirements and may have a disproportionate impact on children.

Yesterday I noted that Idaho, which was the one of the first states to start "redetermining" Medicaid/CHIP enrollees the moment the Medicaid Unwinding process began last spring, has at least completed doing so; in the end, over 121,000 - 145,000 Idahoans got the boot, of which somewhere between 51,000 - 106,000 may still actually be eligible for Medicaid/CHIP coverage due to having their coverage terminated for purely procedural reasons.

Today, there's a consolation prize of sorts; via Your Health idaho:

Special Enrollment Period for the Loss of Medicaid Extended

Idahoans who have lost Medicaid coverage have until Nov 30, 2023, to enroll in health insurance through Your Health Idaho

via Dorothy Mills-Gregg of Inside Health Policy:

While most states are reaching the height of their post-pandemic Medicaid renewals, Idaho is returning to nearly normal redeterminations, closing out the bulk of its pandemic eligibility unwinding after removing more than 121,000 Medicaid and CHIP beneficiaries the state deemed most likely ineligible from the programs in six months.

Hmmm...IHP's estimate is lower than that of KFF's daily tracker, which puts Idaho's total disenrollment number at 145,000 as of today.

Idaho’s Medicaid and Children’s Health Insurance Program enrollment grew by roughly 150,000 people during the pandemic’s continuous coverage requirement, maxing out at about 450,000 beneficiaries. An estimated 42% of the beneficiaries who were disenrolled lost coverage due to procedural or paperwork issues.

Yesterday the U.S. Census Bureau published new reports on Income, Poverty and Health Insurance Coverage in the United States as of 2022. Obviously all three of these are extremely important and interact closely with each other, but given that my focus is healthcare policy, I'm going to stick with the health insurance coverage portion.

According to the 2023 Current Population Survey Annual Social & Economic Supplement (CPS ASEC):

...92.1% of the U.S. population had health insurance coverage for all or part of 2022 (compared to 91.7% in 2021). An estimated 25.9 million or 7.9% of people did not have health insurance at any point during 2022, according to the 2023 Current Population Survey Annual Social and Economic Supplement (CPS ASEC). That compares to 27.2 million or 8.3% of people who did not have health insurance at any point during 2021.

It's been about five months since I last posted about the status of Oregon's pending Basic Health Plan program:

As reported by Megan Messerly of Politico in 2022:

In Oregon, Democrats passed a bill in March to establish a basic health program, the details of which are being ironed out by a task force that began meeting this week. In Kentucky, Republicans approved $4.5 million in state funds this spring to set up a basic health program, which was signed into law by the state’s Democratic governor. An estimated 85,000 Oregonians and at least 37,000 Kentuckians will be eligible to enroll in the plans as soon as next year.

I haven't checked in on how many Americans have lost Medicaid or CHIP coverage due to the ongoing Medicaid Unwinding process playing out nationally since the end of July. Fortunately, KFF (formerly the Kaiser Family Foundation) has been diligently tracking the data, and it continues to be extremely depressing and concerning.

At the time, "only" 3.77 million people had been confirmed to have lost coverage purely due to procedural/red tape reasons (as opposed to others who lost coverage after being determined ineligible any longer).

KFF's data is now pretty comprehensive (it includes nearly every state plus DC), and it's bad if not worse than many healthcare advocates feared as the numbers have continued to grow dramatically:

Over at Inside Health Policy, Amy Lotven has an excellent scoop from a new CMS report which was hiding in plain sight:

New CMS data, quietly released in late August, show about 178,000 consumers chose a qualified health plan (QHP) through a state or federal exchanges after losing Medicaid and CHIP coverage in the first two months of the Medicaid unwinding. Those sign-ups through the end of May are more than three times the 54,000 enrollments that CMS reported in July, which reflected only the April numbers.

via Access Health CT:

These free, in-person events will take place in Litchfield, New Britain, Vernon and Willimantic

HARTFORD, Conn. (Aug. 30, 2023) — Access Health CT (AHCT) can help eligible Connecticut residents enroll in HUSKY Health, the state’s Medicaid program, and Qualified Health Plans. To help residents understand the types of health coverage available to them, AHCT will host free, in-person enrollment fairs in September and October. Many HUSKY Health clients have been affected by “Medicaid Unwinding,” a term the federal government is using to describe the process of resuming reviewing households for Medicaid eligibility after a three-year break during the Public Health Emergency. The eligibility redetermination process resumed April 1 and HUSKY clients will be notified when it is their turn to enroll.

via the Centers for Medicare & Medicaid Services (CMS):

CMS Takes Action to Protect Health Care Coverage for Children and Families

• States must assess and fix their systems so eligible children and families can stay covered. 

Today, and as part of its ongoing work to make sure all Americans have access to health care coverage, the Centers for Medicare & Medicaid Services (CMS) sent a letter to all 50 states, the District of Columbia, Puerto Rico, and the U.S. Virgin Islands requiring them to determine whether they have an eligibility systems issue that could cause people, especially children, to be disenrolled from Medicaid or the Children’s Health Insurance Program (CHIP) even if they are still eligible for coverage, and requiring them to immediately act to correct the problem and reinstate coverage.

via Nevada Health Link:

• Medicaid recipients deemed ineligible for coverage may be eligible for financial assistance and are encouraged to contact Nevada Health Link to avoid a lapse in health coverage

CARSON CITY, Nev. – As the redetermination process associated with the unwinding of the Public Health Emergency continues, Nevada Health Link, Nevada’s health insurance marketplace, is continuing to work diligently to streamline the enrollment process for individuals and households whose increased income no longer qualifies them for Medicaid coverage.