PHE- CMS requires 30 states to pause Medicaid disenrollments after systems error

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[MM Curator Summary]: States incorrectly processing child eligibility and the household level using automated systems are now being “required” by CMS to slow down.



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Nearly 500,000 people will regain Medicaid or Children’s Health Insurance Program coverage after being improperly removed from the rolls during redeterminations, according to the HHS.


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Dive Brief:

  • Federal regulators ordered 30 states to pause procedural disenrollments of Medicaid beneficiaries after warning about inappropriately removing children and other enrollees from coverage during the ongoing redeterminations process. 
  • Last month, the CMS sent a letter to all states, Washington, D.C., Puerto Rico and the U.S. Virgin Islands about a systems issue with automatic renewals. Some states were conducting eligibility checks at the family level, even though some members of the household — like children — face a lower bar to remain covered under the safety-program.
  • Nearly half a million people will regain Medicaid or Children’s Health Insurance Program coverage due to the fix, according to a release from HHS. 

Dive Insight: 

More than seven million Medicaid beneficiaries have been disenrolled from the program geared toward low-income people since the redeterminations process began this spring, according to health policy research firm KFF.

States are required to figure out which enrollees are still eligible for the safety-net program after a long period of continuous enrollment during the COVID-19 pandemic, where beneficiaries were kept enrolled in Medicaid to avoid coverage losses during a public health emergency. 

But patient advocates have raised concerns about the large number of procedural disenrollments, or cuts due to administrative reasons like not completing paperwork. 

Among states with available data, 73% were removed from coverage due to procedural reasons, according to KFF. 

In 16 states reporting age breakouts, children accounted for 42% of Medicaid disenrollments. 

The federal government has taken steps to cut down on the number of inappropriate disenrollments including offering states more flexibility and pausing coverage terminations in states that weren’t compliant with renewal requirements.

“I think unwinding has revealed that there have always been more procedural terminations than we realized. And that’s contributed to the historic patterns of churn on and off of Medicaid that have impacted people’s ability to keep their coverage,” said Allison Orris, senior fellow at the Center on Budget and Policy Priorities, during a meeting of the Medicaid and CHIP Payment and Access Commission Thursday. 

Automatic renewals, or ex parte renewals, use existing data to determine whether beneficiaries are still eligible for coverage, and are key tools to keep people enrolled with lower documentation burden, regulators said. 

But some states were enacting renewals of whole households at once, even though some members may have different eligibility requirements, the CMS said in a letter last month.

Alaska, Colorado, Connecticut, Delaware, Washington, D.C., Georgia, Hawaii, Idaho, Illinois, Iowa, Kansas, Kentucky, Maine, Maryland, Massachusetts, Minnesota, Nebraska, Nevada, New Jersey, New Mexico, New York, North Dakota, Ohio, Oregon, Pennsylvania, Vermont, Virginia, West Virginia, Wisconsin and Wyoming were not auto-renewing at the individual level, according to preliminary data released Thursday.

ennsylvania and Nevada estimated the error affected more than 100,000 people in their states. Other states reported lower numbers or were still assessing the impact.

Dan Tsai, deputy administrator and director of the Center for Medicaid and CHIP Services, said Thursday there’s “no doubt” the Medicaid program will come out of the redeterminations process stronger due to the increased focus on eligibility and outreach.

“I hope this will lead to a renaissance over the next multi-year period of how we in the country collectively think about eligibility and the ease of maintaining and getting access to coverage through Medicaid and other programs,” he said during the MACPAC meeting.