Sep 22, 2023 - Health

Medicaid coverage will be restored for 500K after state reviews

Illustration of a boxing ring bell with the red cross symbol on it.

Illustration: Allie Carl/Axios

A half-million people who improperly lost Medicaid coverage as states review eligibility will have their insurance restored, federal officials said Thursday.

Why it matters: The Biden administration weeks ago warned that some states were improperly vetting whether some people still qualified for Medicaid as they redetermined eligibility for the first time since the pandemic. Thursday's announcement made clear the extent of the problem.

  • Federal health officials disclosed that 30 states made technical errors in redetermining Medicaid eligibility. Those states must stop disenrolling people for procedural reasons — such as failing to return paperwork — until they've fixed glitches in their coverage renewal systems.

Details: Nevada and Pennsylvania each estimated more than 100,000 residents mistakenly lost coverage.

  • Federal officials said they suspect kids make up a significant portion of those unfairly kicked off coverage, but they didn't know how many.
  • Five states — Delaware, Georgia, Minnesota, Nebraska and Oregon — are still assessing how many residents have been affected.

Remember: States have to check existing data to determine someone's Medicaid eligibility before sending them forms to renew coverage. People who meet eligibility requirements based on factors like income will automatically be re-enrolled.

  • The Centers for Medicare and Medicaid Services in August said some states had incorrectly removed coverage for entire households without accounting for the fact that members of a household may have different Medicaid eligibility thresholds.
  • Experts said the issue would primarily affect kids, who are eligible for Medicaid at higher income levels than adults.
  • At least 1.3 million children have lost Medicaid coverage since April, according to KFF.

Medicaid directors on Thursday said they were essentially blindsided by this issue but are working to remedy it fast and reinstate coverage.

  • Before states began redeterminations in April, CMS didn't clarify that states should stick to individual-level renewals, said Kate McEvoy, executive director of the National Association of Medicaid Directors.
  • "[T]his issue around individual versus household [renewals] wasn't billboarded" when CMS issued guidance on the redetermination process in January, she said.
  • Some Medicaid departments used household-level renewals in an effort to streamline the process for beneficiaries, McEvoy added.

What they're saying: "We have had success in keeping eligible people covered, so this is obviously not something we are proud of. But we are highly focused and working around the clock to address it," Amir Bassiri, New York's Medicaid director, said on a call with reporters.

  • He said affected state residents should start getting coverage back as soon as Friday.
  • Dan Tsai, director of the Center for Medicaid and CHIP Services, said states are fixing their systems on different timelines. He did not say how quickly coverage will be restored across the country.
  • People who were mistakenly removed can get retroactive coverage for the period in which they lost Medicaid, he said.
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