Medicaid Redeterminations Losses Exceeding Predicted Levels In Some States

Dive Brief:

• The number of Medicaid beneficiaries losing coverage because of redeterminations has blown past initial estimates in some states, resulting in significant shifts in coverage, according to a new analysis.
• Eight states have already exceeded their projected disenrollment of adults, while 12 states have exceeded their projected disenrollment of children, according to the research from the Urban Institute, funded by the Robert Wood Johnson Foundation.
• States with notably higher disenrollment rates pledged to finish redeterminations in under a year, didn’t take advantage of federal flexibilities streamlining the process or prioritized checking the eligibility of people unlikely to still qualify for Medicaid, the analysis found.

Dive Insight:

States were barred from disenrolling people from Medicaid or the Children’s Health Insurance Program during the COVID-19 pandemic in return for more generous federal funding, causing enrollment in the programs to skyrocket to a record one in four Americans.

However, states began rechecking members’ eligibility last spring, and millions of Americans have been kicked off Medicaid because of that process, known as redeterminations, so far.

Earlier research conducted by the Urban Institute predicted Medicaid and CHIP enrollment would fall by 15 million people overall during redeterminations. Net disenrollment through November is consistent with that prediction, at almost 61% of the projected total, according to the new analysis.

However, the pace of disenrollments vary widely by state, given different approaches in pursuing unwinding.

“Certain states disenrolled more people from Medicaid in eight months than we projected would be disenrolled over the full course of the unwinding,” Matthew Buettgens, a senior fellow at the Urban Institute, said in a statement on the group’s new report.

Researchers found Medicaid disenrollment exceeded 100% of a state’s total projection in eight states: South Dakota, New Hampshire, Texas, Arkansas, Iowa, Idaho, Montana and Oklahoma.

The findings suggest many eligible people may be losing coverage, a problem that could worsen as redeterminations continue, Buettgens said. It adds more fodder to a voluminous body of research finding high levels of procedural disenrollments — when people lose coverage despite still being eligible, due to some states moving too quickly in rechecking their rolls.

Seventy percent of people disenrolled from Medicaid had their coverage terminated for procedural reasons, like states having incomplete paperwork or being unable to reach an enrollee, according to KFF.

It’s an especially acute concern when it comes to children, who are at higher risk than adults of negative health consequences due to care disruptions because of rapid development at young ages, according to the report.

Children have been disenrolled at higher rates than adults, according to the Urban brief. Nationally, disenrollments for children reached 84.2% of projections, and disenrollments exceeded total projections in 12 states: Montana, Iowa, South Dakota, Alabama, Idaho, Georgia, Texas, Arkansas, Oklahoma, Florida, Mississippi and Colorado.

Some states have temporarily paused terminations — voluntarily or otherwise — over the past year after finding issues causing procedural disenrollments.

In September, for example, the CMS required 30 states to pause disenrollments after finding a systems error that was improperly disenrolling hundreds of thousands of people, including children. In December, regulators called out nine states with disproportionately large disenrollment among children, and took steps to crack down on states that aren’t complying with monthly reporting or eligibility requirements.

To date, more than 21 million people have lost Medicaid due to redeterminations, according to a KFF tracker, with redeterminations roughly two-thirds complete. States are expected to finish unwinding by the middle of this year.