USA — Biden’s administration has called on states to halt their rapid removal of individuals from Medicaid rolls, citing worries that a significant number of lower-income individuals are losing healthcare coverage due to administrative reasons.
During the COVID-19 pandemic, Medicaid enrollment surged as states were prohibited from terminating coverage.
However, since April, states have been required to re-evaluate the eligibility of recipients, a process that was routine before the pandemic.
Disturbingly, data submitted to the Centers for Medicare & Medicaid Services (CMS) and obtained by The Associated Press reveals that approximately half of the Medicaid renewal cases decided in April or May in certain states have resulted in coverage loss, primarily due to “procedural reasons” like the failure to return forms.
Health and Human Services Secretary Xavier Becerra expressed his concern over unnecessary coverage losses in a letter to governors, particularly emphasizing the avoidable reasons that state Medicaid offices have the power to prevent or mitigate.
To address this issue, federal officials are advising state Medicaid agencies to postpone procedural terminations for one month while conducting targeted outreach to recipients.
They are also encouraging states to involve managed healthcare plan providers in assisting individuals with Medicaid renewal forms.
Secretary Becerra stressed that no one should lose coverage due to address changes, form non-receipt, or insufficient information about the renewal process.
States are progressing at varying speeds in conducting Medicaid eligibility evaluations. While some states have not yet dropped anyone from their rolls, others have already removed tens of thousands of individuals.
Preliminary data reported to CMS by 18 states reveals that approximately 45% of those whose renewals were due in April retained their Medicaid coverage, about 31% lost coverage, and approximately 24% were still in the processing stage.
Among those who lost coverage, 4 out of 5 cases were attributed to procedural reasons, as stated by the U.S. Department of Health and Human Services.
Alarming statistics from the Associated Press analysis indicate that in Arkansas, Florida, Idaho, New Hampshire, and Oklahoma, approximately half or more of the individuals whose eligibility cases were completed in April or May lost their Medicaid coverage.
It’s important to note that these figures may seem high because some states prioritized the process by beginning with individuals who were already deemed unlikely to remain eligible.
CMS officials have raised specific concerns regarding Arkansas, where over 100,000 Medicaid recipients have been dropped, mainly due to non-compliance with renewal forms or requested information.
Arkansas officials argue that they are following a timeline mandated by a 2021 law, which requires the state to complete redeterminations within six months of the end of the public health emergency.
The state’s Department of Human Services asserts that Medicaid recipients receive multiple notices and additional forms of communication before their coverage is terminated.
However, healthcare advocates find it troubling when a substantial number of individuals are removed from Medicaid due to failure to respond to re-enrollment notices, as they often remain unaware of the coverage loss until they require medical care or attempt to fill prescriptions.
Allie Gardner, a senior research associate at the Georgetown University Center for Children and Families, highlights the issue of procedural disenrollment, stating that individuals who experience this are often unaware of their coverage loss until they encounter difficulties accessing medical services.
The concern lies in the fact that these individuals may only discover the loss when seeking medical attention or attempting to fill prescriptions, resulting in unexpected challenges.
As the Biden administration urges states to reconsider their Medicaid roll purges, it remains crucial to strike a balance between maintaining program integrity and ensuring that eligible individuals, particularly those from vulnerable populations, do not inadvertently lose access to essential healthcare services.
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