PHE (CMS)- Medicaid unwinding paused in some states as CMS finds violations

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[MM Curator Summary]: CMS tells a small group of reporters that it is going after states that are doing RTNO too fast.



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The Centers for Medicare and Medicaid Services is taking action to stem the tide of Medicaid and Children’s Health Insurance Program enrollees losing benefits for procedural reasons as states carry out eligibility redeterminations, federal officials said Wednesday.

So far, at least 3 million Medicaid beneficiaries have lost coverage in 33 states and the District of Columbia since eligibility checks resumed in April, according to data compiled by KFF. The redeterminations process, suspended during the COVID-19 public health emergency, is intended to remove people who no longer qualify for the programs. Yet a significant portion of those disenrolled have lost benefits for other reasons, such as state agencies being unable to contact them, provoking consternation from federal authorities.

“Despite all the preparations and what we know has been a tremendous amount of work at the state level and in the community, we are very concerned about the level of terminations,” Center for Medicaid and CHIP Services Director Daniel Tsai said during a news conference.

The Health and Human Services Department projects that 15 million people will lose Medicaid coverage once redeterminations are complete.

CMS has already ordered several states to pause redeterminations to address their failure to adhere to federal standards and is working with about a half dozen states to correct ongoing violations, Tsai said. The agency has required some states to pause so-called procedural terminations not related to eligibility and to reinstate coverage for those affected by policy, operational or compliance violations, he said. CMS is monitoring an additional dozen states to determine if they are in violation of Medicaid regulations.

One state failed to provide some enrollees with renewal forms, and another didn’t implement required auto-renewal mitigation strategies, according to a CMS fact sheet. The agency continues to monitor states, intervene when necessary and offer technical assistance.

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“We are really asking every state to take up a whole host of policy waivers and strategies that we’ve outlined over the past year and a half, and additional policy waivers we put out over the past month that really will help make the Medicaid eligibility process easier, and help keep eligible people covered,” Tsai said.

States that fail to adhere to federal rules designed to protect eligible beneficiaries could lose federal dollars that support their Medicaid budgets, Tsai said. “Their entire enhanced federal match for the quarter that’s been outlined by statute is at risk, and that’s a significant amount of funding,” he said.

CMS would not disclose what states it has targeted, but CMS Administrator Chiquita Brooks-LaSure said the agency would name them if those states fail to resolve their problems.