Medicaid Redefinition Leads to Many Exclusions from Enrollment

Arkansas removed more than 72,000 people from Medicaid in April, the first month states could start cutting programs. Affected people who believe they are still eligible for coverage can provide the state with missing information to maintain or restore benefits, a spokesman for the Arkansas Department of Health wrote in an email.

Nearly 250,000 Medicaid beneficiaries lost their coverage in Florida last month, more than 82.2% of them for procedural reasons. The Florida Department of Health did not respond to interview requests.

Indiana boasts the highest procedural failure rate to date at 88.5%. Medicaid listings in the state have increased to 2.2 million during the pandemic, a spokesman for the Indiana Department of Family and Human Services said in an email. Some enrollees likely did not respond to state requests because they know they are no longer eligible, the spokesperson wrote. In addition to sending out notifications, sending text messages and making phone calls to recipients, the agency is running a paid advertising campaign, a spokeswoman writes.

States are investing in new technology systems, training an army of brokers, and partnering with companies and health insurance providers to reduce coverage losses.

Despite these efforts, most Medicaid beneficiaries are unaware that states have resumed eligibility reviews, according to survey results released Wednesday by the Kaiser Family Foundation. Sixty-five percent of respondents were unaware of the redefinition of Medicaid, and another 7%—a disproportionate number of blacks or Hispanics—incorrectly believe that states are not allowed to exclude people from the program. Nearly 30% said they did not know where to get replacement insurance, and 15% expected to remain uninsured.

CMS should require states with high procedural failure rates to submit corrective action plans or suspend re-determinations, said Lucy Dagno, senior director of state and local Medicaid campaigns at the American Cancer Society Cancer Control Network. “What worries us is that it doesn’t seem clear that states necessarily know why their procedural failure rate is so high,” she said.

Long wait times at the call center, mail delays, and fraud reports further complicate the process for participants.

West Virginia, for example, is reviewing other states’ Medicaid systems to see if their residents are covered elsewhere. If a member has an open case in another state, West Virginia removes the member from Medicaid and initiates a fraud investigation, said Miriam Delaney Hurd, senior lawyer for the National Health Law Program. To restore Medicaid coverage in West Virginia, she said, beneficiaries must close their out-of-state files and prove they didn’t commit fraud.

“They demand that the person close the case in another state. How is that even possible?” Delaney Hurd said. “You call these call centers and you can’t get through to anyone, and even so, whichever state they come from, they also go through a redefinition. How high will that be on their radar? The West Virginia Bureau of Health Services did not respond to interview requests and the state did not release updated enrollment information.

More than 1,700 people in South Dakota lost their Medicaid in April and will become eligible when the Medicaid expansion goes into effect on July 1. The South Dakota Department of Human Services declined to comment.

North Carolina is also poised to expand Medicaid after the state passed the policy in March. North Carolina will begin redefining in July, months before the expansion goes into effect, said North Carolina Medicaid deputy director Jay Ludlam. In the meantime, the state plans to help those leaving Medicaid find replacement coverage and then enroll eligible people in extended Medicaid when it becomes available, he said.

“They don’t have to fill out any paperwork. It will be invisible to them. They will be enlisted in the expansion team,” Ludlam said.

Arizona Medicaid, known as the Arizona Health Care Containment System, has excluded 33,705 people who signed up for Medicaid during the federal public health emergency and 6,126 people who had Medicaid before the COVID-19 pandemic, spokeswoman Heidi Capriotti said. .

Arizona has been constantly monitoring enrollment information during the pandemic, she said, making it easier for the state to assess which beneficiaries are most likely to no longer qualify. In addition, according to Capriotti, civil servants do not need training or retraining for recertification. “I would say the process is going as smoothly as expected,” she said.

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