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June 13, 2023 : The Biden administration has called on states to halt their rapid removal of individuals from Medicaid rolls, expressing alarm over the significant number of lower-income people losing healthcare coverage due to administrative reasons.
During the COVID-19 pandemic, Medicaid enrollment increased as states were barred from terminating coverage. However, this changed in April when states were required to reassess recipients’ eligibility, a process they regularly conducted before the pandemic.
Data submitted to the Centers for Medicare & Medicaid Services (CMS) and obtained by The Associated Press revealed that approximately half of those whose Medicaid renewal cases were decided in April or May had lost their coverage in some states. CMS attributed this primarily to “procedural reasons,” such as failure to submit required forms.
In a letter to governors on Monday, Health and Human Services Secretary Xavier Becerra expressed deep concern over the unnecessary loss of coverage, particularly among those who could have been prevented or assisted by state Medicaid offices. The Biden administration advises state Medicaid agencies to delay procedural terminations for one month and engage in targeted outreach to recipients before dropping them for non-response. They also encourage states to allow managed healthcare providers to assist with Medicaid renewal forms.
Becerra emphasized that individuals should not lose coverage due to address changes, missed forms, or lack of information about the renewal process.
States have varied in their pace of conducting Medicaid eligibility determinations. Some have yet to remove anyone from their rolls, while others have already dropped tens of thousands of people.
Preliminary data from 18 states, reported to CMS, revealed that about 45% of those whose renewals were due in April maintained their Medicaid coverage, approximately 31% lost coverage, and around 24% were still being processed. Among those who lost coverage, 4 out of 5 cases were due to procedural reasons, according to the U.S. Department of Health and Human Services.
The AP’s data analysis highlighted Arkansas, Florida, Idaho, New Hampshire, and Oklahoma as states where about half or more individuals whose eligibility cases were completed in April or May lost their Medicaid coverage. However, these figures might appear high because some states prioritized individuals unlikely to remain eligible.
CMS officials have expressed specific concerns regarding Arkansas, where over 100,000 Medicaid recipients have been dropped, primarily due to non-response to renewal forms or requested information.
Arkansas officials have stated that they are following a timeline mandated by a 2021 law, which requires the completion of redeterminations within six months of the end of the public health emergency. They have indicated that Medicaid recipients receive multiple notices, texts, emails, and phone calls, when possible, before their coverage is terminated. The Arkansas Department of Human Services added that some individuals may not respond because they know they are no longer eligible.
While Republican Governor Sarah Huckabee Sanders defended the state’s redetermination process, claiming it brings the program back to its pre-pandemic coverage intentions, healthcare advocates are troubled when many individuals are removed from Medicaid due to failure to respond to re-enrollment notices. Such individuals often remain unaware of the loss of coverage until they attempt to access medical services or fill prescriptions, highlighting the potential harm caused by procedural disenrollment.
Allie Gardner, a senior research associate at the Georgetown University Center for Children and Families, emphasized the importance of addressing this issue, as those who are procedurally disenrolled may not realize they have lost coverage until they seek medical assistance.
