Tag: Enrollment

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PHE- Arizona House’s Health Committee approves bill to shorten Medicaid redeterminations by three months, despite concerns over condensed timeline

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: AZ wants to stop paying $5M in state funds each month that it shouldn’t as soon as it can.

 
 

 
 

Clipped from: https://stateofreform.com/featured/2023/02/arizona-houses-health-committee-approves-bill-to-shorten-medicaid-redeterminations-by-three-months-despite-concerns-over-condensed-timeline/

 
 

Hannah Saunders | Feb 28, 2023 | Arizona

The Arizona House’s Health and Human Services Committee met on Feb. 16th to discuss House Bill 2624 as it relates to Medicaid redeterminations. The bill would require the Arizona Health Care Cost Containment System (AHCCCS) to complete Medicaid redeterminations for all members by Dec. 31st, 2023, and remove individuals who were not determined to be eligible. 

This spring, Medicaid redeterminations will take place in Arizona for the first time in three years. Since the onset of the COVID-19 pandemic, the federal public health emergency’s continuous coverage provision has kept members from being dropped from Medicaid—even if they became ineligible due to changes in income.  

 
 

 
 

Bill sponsor Rep. Leo Biasiucci (R – Gilbert) stated that about 600,000 individuals on AHCCCS will no longer qualify, and that ineligible members need to be removed swiftly as their continued Medicaid coverage costs the state about $5 million per month.

Sam Adolfson, a visiting fellow at the Opportunity Solutions Project, brought up how he has worked with other states across the country, some of which are completing redeterminations in shorter time frames, such as three to six months. He noted there has been no change to Medicaid eligibility criteria, but that this process will disenroll ineligible members from the program. 

Willa Murphy of AHCCCS provided some context, stating that over 2.4 million members will undergo a redetermination, with disenrollment prepared to start on April 1st. She noted the potential consequences of shortening the 12-month redetermination window in Arizona.

“By condensing the redetermination window from 12 months, as currently planned, to nine months—this would require additional eligibility staff in order to meet the deadline,” Murphy said. “There is a potential ongoing impact because of the annual redeterminations cycle, so it may create a redetermination surge moving forward as a result of this window narrowing.”

The estimated preliminary increase in staffing levels needed for AHCCCS eligibility redeterminations is 33%, which would cost approximately $16,700,000 from the general fund, and $47,700,000 from the total fund, according to Murphy. 

Jennifer Carusetta, vice president of public affairs and advocacy for Phoenix Children’s Hospital, provided public testimony in opposition to this bill. Her greatest concern is having children with complex medical needs and children experiencing crises undergo a lapse in care due to redeterminations being conducted on a condensed timeline.

“Time matters for these kids. Time matters for these families,” Carusetta said. “When you are going through a redetermination process, you are going to be notified that you owe AHCCCS information. We want to make sure that these families get AHCCCS that information.” 

Carusetta said she is supportive of the original redeterminations timeline, and that she is concerned about potential confusion with mixed deadlines, and the potential for individuals to be dropped from coverage due to a rushed process. 

“We are concerned about families who do not have adequate time to identify a network of providers to meet children’s complex medical needs,” Carusetta said. 

Drew Schaffer of the William E. Morris Institute for Justice, a nonprofit organization dedicated to protecting the rights of low-income Arizonans, also testified in opposition and stated that AHCCCS has never attempted something of this magnitude before. 

“What we see here with House Bill 2624 is an unnecessary acceleration of a plan that has been thoughtfully put in place for a long time,” Schaffer said. 

Schaffer’s concerns included the 600,000 estimate of individuals who do not qualify is only an estimate, and mentioned how there is still a large portion of individuals who have no contact with AHCCCS and cannot ascertain eligibility. 

The committee approved the bill by a narrow vote of 5-4. The Arizona House’s Rules Committee is hearing the bill on Feb. 27th for further determination. 

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PHE- More than 60% of Adults Unaware of Medicaid Eligibility Redetermination

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: Most er-body that’s gonna get redetermin’d don’t know they’re gonna get redetermin’d.

 
 

 
 

Clipped from: https://www.healthleadersmedia.com/payer/more-60-adults-unaware-medicaid-eligibility-redetermination

The impending renewal process could mean enrollees are left without coverage.

KEY TAKEAWAYS

A survey from the Urban Institute finds that 64% of adults in a Medicaid-enrolled family have no idea that they may lose coverage with the return to regular Medicaid renewal processes.

There has been almost no change in awareness since the previous survey results from June 2022, when 62% of enrollees said they were unaware.

States and the federal government can raise awareness to alleviate potential mass coverage loss.

Most adults in a Medicaid-enrolled family lack awareness of the upcoming Medicaid eligibility redetermination, according to analysis from the Urban Institute, funded by the Robert Wood Johnson Foundation.

April 1 is the deadline for states to start redetermining eligibility of Medicaid beneficiaries and the survey by the Urban Institute finds 64.3% of enrollees have heard nothing about the return to regular Medicaid renewal processes as of December 2022.

That’s virtually no change when compared to survey results from June 2022, when 62% of beneficiaries reported being unaware of redeterminations.

The most recent survey uncovers that 16% of adults have heard only a little about the return to regular renewal processes, while 13.9% have heard some, and 5.1% have heard a lot.

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Regardless of geographical location, awareness remains low. Lack of awareness was 66.5% in the Northeast, 67.6% in the Midwest, 63.4% in the South, and 61.3% in the West.

Whether respondents were in a state that has expanded Medicaid eligibility made no difference either. Lack of awareness was 64.5% in Medicaid expansion states and 63.7% in non-expansion states.

“The end of the public health emergency’s continuous coverage requirement means millions of people are at risk of losing continuous coverage in Medicaid, which they have relied upon for nearly three years,” Gina R. Hijjawi, senior program officer at the Robert Wood Johnson Foundation, said in a statement.

 
 

“States and the federal government must quickly raise awareness that many families will soon need to take steps to maintain or find new health coverage.”

As many as 18 million people could lose Medicaid coverage with the COVID-19 public health emergency ending, the Urban Institute states.

States and the federal government can do their part to offset coverage loss by raising awareness that families will have to take steps to maintain or find new coverage on the Affordable Care Act marketplace.

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PHE- Maximus eyes growth as states restart Medicaid initiatives

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: Key fact – 39% of Medicaid bennies live in states with no current redetermination vendor partner. Translation = Maximus can capture at least 39% of the gigantic redetermination support opportunity.

 
 

 
 

Clipped from: https://washingtontechnology.com/companies/2023/02/maximus-eyes-growth-states-restart-medicaid-initiatives/382840/

 
 

Maximus CEO Bruce Caswell sees growth ahead from the company’s clinical and eligibility services work. Courtesy of Maximus.

Several trends are converging that Maximus sees as driving growth for the rest of its current and next fiscal years, executives said in their first quarter earnings call with investors Thursday.

Two things top their list of positive indicators:

  • The fiscal 2023 omnibus spending bill includes funds and a timeline for states to resume making annual Medicaid redeterminations.
     
  • The Veterans Affairs Department is gearing up to meet the requirements of the PACT Act, which expands health care and other benefits for veterans exposed to toxins including burn pits.

Medicaid redeterminations are an established business for Maximus, but annual redeterminations were paused during the COVID-19 pandemic.

During the call with analysts, Maximus CEO Bruce Caswell called the restarts of the redeterminations a “significant development” given the clinical and eligibility services the company provides.

There will be a early spike in work as states restart the redeterminations, but this will not be a boom like Maximus’ COVID response support.

Caswell said the redetermination work is a sustainable business over the long term and one Maximus expects to be larger than before COVID.

Before COVID, there were 71 million Medicaid recipients who had to go through annual redeterminations. Caswell said that number has climbed to 91 million since the start of the pandemic in 2020.

Maximus Chief Financial Officer David Mutryn said the company expects to see the increase in work during its third fiscal quarter. The company’s fiscal year aligns with that of the federal government’s October-September calendar, so Maximus is currently in its second quarter.

McLean, Virginia-headquartered Maximus has contracts with 17 states that could turn into redetermination work. Thirty-nine percent of citizens enrolled in Medicaid live in states that do not have a contractor to help with redeterminations.

“These are customers that, if they find themselves in a pinch, that we can develop relationships with and add, if you will, new state customers through this process,” Caswell said.

Fewer details emerged from the call regarding the PACT Act, but Caswell said they are starting to see a volume increase as the VA works through the initial claims for benefits.

“It’s logical to assume that volumes will settle to a higher level than present over the longer term,” Caswell said.

With the environment for growth clear, Maximus has increased its current fiscal year revenue to between $4.85 billion and $5 billion.

First [quarter] revenue climbed 8.5% from the prior year period to $1.25 billion.

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DUALS- Two New Reports Provide an Overview of the 12.5 Million People Enrolled in Both Medicare and Medicaid

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: We are still hovering around 12M duallies, but what they need and get has changed a bit since the last time a big report was done.

 
 

 
 

Clipped from: https://www.medicarerights.org/medicare-watch/2023/02/09/two-new-reports-provide-an-overview-of-the-12-5-million-people-enrolled-in-both-medicare-and-medicaid

 
 

For dually-eligible individuals, Medicare is their primary insurer and mainly pays for medical services, such as hospital and post-acute care. Medicaid wraps around this coverage, providing varying levels of assistance with Medicare costs and paying for services Medicare does not, such as long-term services and supports (LTSS).

While nearly all Medicare-Medicaid enrollees have low incomes and modest savings, they are a diverse group with respect to age and health status. Most are over 65, but many are not. Some are relatively healthy, and others have significant impairments. A Kaiser Family Foundation (KFF) brief examines these and other enrollee characteristics with several key takeaways:

  • In 2020, 87% of Medicare-Medicaid enrollees (and 20% of Medicare-only enrollees) had incomes of $20,000 or less.
  • Almost 40% of dually-eligible individuals were under age 65 and qualified for Medicare due to disability, compared to 8% of non-dual Medicare enrollees.
  • Nearly half (49%) were people of color, compared to less than 20% of non-dual Medicare beneficiaries.
  • More than four in 10 Medicare-Medicaid enrollees (44%) were in fair or poor health, compared to 17% of Medicare-only beneficiaries.
  • Nearly half (48%) had at least one limitation in activities of daily living (ADLs) compared to 23% of non-dual Medicare enrollees.

An updated data book from the Medicaid and CHIP Payment and Access Commission (MACPAC) and the Medicare Payment Advisory Commission (MedPAC) presents similar personal information. It also highlights trends in enrollment, costs, and utilization among Medicare-Medicaid enrollees. The findings include the following:

  • More dually-eligible beneficiaries are enrolling in Medicare Advantage (MA). The share of those in Original Medicare declined by 7.7% between 2018 and 2020, while the share enrolled in MA increased by 8.6%. Medicare-Medicaid enrollees are more likely to be in an MA plan than their non-dual counterparts (41% vs. 35%).
  • Dually eligible individuals used certain Medicare-covered services more than Medicare-only enrollees; their per-person Medicare spending was also higher. From 2018 to 2020, Medicare spending on dually eligible individuals increased for skilled nursing facility services (11%), inpatient hospital services (7.6%), home health (5.4%), and Part D drugs (5.8%). Among non-dually eligible Medicare enrollees, spending increased by 5.8%, 6.5%, and less than .1%, respectively.
  • The use of Medicaid-covered institutional LTSS was associated with disproportionately high Medicare and Medicaid spending. Users of institutional LTSS made up 17% of dually-eligible beneficiaries but accounted for 31% of Medicare spending and 39% of Medicaid spending on this population. They had the highest Medicare and Medicaid spending compared with users of other types of Medicaid LTSS.
  • Over the last two decades, federal and state efforts have focused on shifting LTSS use from institutional settings toward home- and community-based services (HCBS). In 2020, the share of dually-eligible beneficiaries who used HCBS LTSS was larger than the share who used institutional LTSS (27% vs. 17%), and HCBS accounted for a greater share of Medicaid spending than institutional LTSS (44% vs. 39%).

Together, the reports underscore the opportunities and challenges to improving outcomes and systems for Medicare-Medicaid enrollees. Policymakers have long expressed interest in doing so, in part because dually-eligible beneficiaries account for relatively large portions of program expenditures. In 2020, they comprised 17% of the Medicare population and 33% of total spending. They similarly accounted for 14% of all Medicaid enrollees and 32% of Medicaid spending. Concerns have also been raised as to how the separate programs create barriers to care coordination and the extent to which this increases costs and worsens health.

Medicare Rights supports thoughtful innovations and urges that any potential solutions be carefully considered. As KFF notes, dually-eligible enrollees have distinct needs and circumstances. They have lower incomes, are more racially and ethnically diverse, and are more likely to be in poor health than Medicare-only enrollees. But while many live with serious physical and mental health challenges, nearly one in four say they are in “excellent” or “very good” health, and more than half have no functional limitations. This heterogeneity makes it critical that reforms are targeted enough to meaningfully strengthen program integration and flexible enough to meet the full range of enrollee needs.

Read the KFF brief, A Profile of Medicare-Medicaid Enrollees.

Read the MACPAC and MedPAC data book, Beneficiaries Dually Eligible for Medicare and Medicaid.

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ENROLLMENT- CMS releases latest enrollment figures for Medicare, Medicaid, Children’s Health Insurance Program (CHIP), and ACA Marketplaces

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: Your new numbers, ladies and gentlemen.

 
 

Clipped from: https://www.wbiw.com/2023/02/01/cms-releases-latest-enrollment-figures-for-medicare-medicaid-childrens-health-insurance-program-chip-and-aca-marketplaces/

 
 

INDIANA – Tuesday, the Centers for Medicare & Medicaid Services (CMS) released the latest enrollment figures for Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP). In addition, last week CMS released the latest number of people that signed up for health care coverage in ACA Marketplaces during the 2022-2023 Open Enrollment Season. These programs serve as key connectors to care for millions of Americans.

Medicare

As of October 2022, 65,236,564 people are enrolled in Medicare. This is an increase of 132,757 since the last report.

35,022,974 are enrolled in Original Medicare.

30,213,590 are enrolled in Medicare Advantage or other health plans. This includes enrollment in Medicare Advantage plans with and without prescription drug coverage.

50,666,744 are enrolled in Medicare Part D. This includes enrollment in stand-alone prescription drug plans and the Medicare Advantage plans that offer prescription drug coverage.

Over 12 million individuals are dually eligible for Medicare and Medicaid, so are counted in the enrollment figures for both programs.

Beginning this month, CMS’ Medicare enrollment data will include low-income subsidy enrollment, including counts of Part D enrollees receiving the full or partial low-income subsidy. Many stakeholders have requested this data and we are pleased to make it available. Detailed enrollment data can be viewed here.

Medicaid and Children’s Health Insurance Program (CHIP)

As of October 2022, 91,342,256 people are enrolled in Medicaid and CHIP. This is an increase of 462,322 since the last report.

84,374,871 are enrolled in Medicaid

6,967,385 are enrolled in CHIP

For more information on Medicaid/CHIP enrollment, including enrollment trends, visit here.

2022-2023 Marketplace Open Enrollment

The Biden-Harris Administration announced that a record-breaking more than 16.3 million people have selected an Affordable Care Act (ACA) Marketplace health plan nationwide during the 2023 Marketplace Open Enrollment Period (OEP) that ran from Nov. 1, 2022-January 15, 2023 for most Marketplaces.  This is an increase of over 1.8 million more people that have signed up for health insurance, or a 13% increase, from this time last year. 

3.6 million plan selections are from people who are new to the Marketplaces, a 21% increase over last year.

12.7 million people who had active 2022 coverage and made a plan selection for 2023 coverage or were automatically re-enrolled.

To view the final Marketplace enrollment snapshot report, click here. 

Every day, CMS ensures that people across the U.S. have coverage that works. See the latest coverage totals across all CMS programs at https://www.cms.gov/pillar/expand-access. This information is updated on a monthly basis. Enrollment data for CMS programs are compiled on different timelines owing to the unique nature of each program.

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PHE- Navigating the New FMAP Glidepath – FMAP Changes in the Consolidated Appropriations Act of 2023

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The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: There is now a schedule of decreasing FMAP to land the plane by year end. Sort of. If you follow all the rules exactly like CMS says you should (think Van Halen and green M&Ms).

 
 

Clipped from: https://www.dentons.com/en/insights/alerts/2023/january/5/navigating-the-new-fmap-glidepath

 
 

In response to the COVID-19 pandemic and the expected economic downturn, Section 6008 of the Families First Coronavirus Response Act of 2020 (Families First) established a temporary 6.2% increase in the Medicaid federal medical assistance percentage (FMAP), effective January 1, 2020, to last through the last day of the calendar quarter in which the COVID-19 public health emergency (PHE) ended. One condition of the FMAP increase was a prohibition on Medicaid disenrollment during the PHE.

The Consolidated Appropriations Act of 2023 (Pub. L. 117-328) – enacted over the holidays – makes several notable changes to the FMAP increase and related Medicaid eligibility redetermination and disenrollment requirements. Although these FMAP changes are obviously important to States, they are also important to providers and local government entities that may be funding the non-federal share of Medicaid payments through intergovernmental transfers or provider taxes. 

FMAP Increase Transition Period

Section 5131 of Division FF of the Consolidated Appropriations Act of 2023 establishes a “transition period” for the Families First FMAP increase:

Time periodIncrease

  

  

January 1, 2020 through March 31, 2023

6.2 percent

April 1, 2023 through June 30, 2023

5 percent

July 1, 2023 through September 30, 2023

2.5 percent

October 1, 2023 through December 31, 2023

1.5 percent

New Conditions

Section 5131 also imposes new conditions on States’ receipt of the enhanced FMAP during the transition period beginning April 1, 2023.  In particular:

Eligibility Redeterminations.— A State that fails to meet any of the following conditions will not qualify for the FMAP increase for the applicable calendar quarter:

  • Eligibility redeterminations must be in accordance with all Federal requirements.
  • The State must attempt to ensure up-to-date contact information (including a mailing address, phone number, and email address) for each eligibility redetermination using the National Change of Address Database Maintained by the United States Postal Service, State health and human services agencies, or other reliable sources of contact information.
  • The State may not disenroll any individual based on returned mail unless the State first undertakes a good faith effort to contact the individual using more than one modality.

Note that these requirements do not prohibit a State from initiating renewals, post-enrollment verifications, and redeterminations over a 12-month period for all individuals who are enrolled in the State’s Medicaid program as of April 1, 2023.

Reporting Requirements.—The FMAP for a State that does not satisfy new reporting requirements will be reduced by 0.25 percentage points times the number of fiscal quarters for which the State has failed to satisfy such requirements, although the reduction can be no greater than 1 percentage point. Specifically, beginning April 1, 2023 and lasting through June 30, 2024, each State will be required to submit monthly reports to the Department of Health and Human Services (HHS) on the State’s activities relating to eligibility redeterminations, including, but not limited to, the number of eligibility renewals initiated and the number of individuals whose Medicaid coverage was terminated. These reports will be publicly available.

In addition, if HHS determines that a State did not comply with eligibility redetermination and reporting requirements during the April 1, 2023 to June 30, 2024 period, HHS may, in addition to other remedies, require that the State submit and implement a corrective action plan. If a State fails to submit or implement an approved corrective action plan, HHS may require the State suspend making all or some eligibility terminations and may impose civil money penalties of up to $100,000 per day.

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PHE- Nebraska Medicaid to resume regular reviews of Medicaid eligibility

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: Nebraska says “its go time.”

 
 

Clipped from: https://www.custercountychief.com/news/nebraska-medicaid-to-resume-regular-reviews-of-medicaid-eligibility/article_e08df62c-91d9-11ed-a53e-2316311697b9.html

 
 

Following the recent passage of federal legislation, the Nebraska Department of Health and Human Services (DHHS) is preparing to resume regular reviews of Medicaid eligibility. Since the beginning of the COVID-19 pandemic, Medicaid members have kept Medicaid coverage even if no longer eligible.

Starting March 1, 2023, each Medicaid member’s current eligibility will be reviewed. It will take approximately twelve months to review all cases.

Medicaid members must ensure their contact information is up to date with Nebraska Medicaid. If information is needed from a member to confirm current Medicaid eligibility, Nebraska Medicaid needs to be able to reach the member. If Nebraska Medicaid is not able to reach the member, the member could unnecessarily lose Medicaid coverage.

Members can make sure their contact information is up to date by logging into their ACCESSNebraska account or calling toll-free (855) 632-7633.

In partnership with its health plans, Nebraska Medicaid will take extra steps to reach its members. These steps will include not only traditional letters but also phone calls and other outreach.

In partnership with provider and advocacy organizations, Nebraska Medicaid will be providing written materials in coordination with the organizations who have helped develop the materials for provider’s offices and other locations. Social media will also be used for outreach.

“Our goal is to make sure that Medicaid members who remain eligible keep their Medicaid coverage,” DHHS CEO Dannette R. Smith, said.

“This will be an historic effort,” Kevin Bagley, Nebraska Medicaid director, said. “We will continue to work with our health plans, our providers, and our community partners to ensure that our members can continue to access the coverage for which they are eligible.”

Members who are found ineligible for Medicaid will have their information forwarded to the federal marketplace. The marketplace will follow up with members about other coverage options; depending on the member’s situation, coverage may be at no or relatively little cost.

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PHE- As Congress Sunsets a Covid-Era Medicaid Program, Millions Could Lose Coverage

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: Some more deets on the rules on how to do the wind-down. Key fact- CMS will hit states with $100k/day penalties if a state decides to start back eligibility determinations and doesn’t do it the way CMS likes. Class- where do we think this is headed?

 
 

 
 

Clipped from: https://www.route-fifty.com/health-human-services/2023/01/congress-sunsets-covid-era-medicaid-program-millions-could-lose-coverage/381571/

 
 

 

By Kery Murakami,
Senior Reporter

Millions of low-income people could begin losing their Medicaid coverage as soon as April after Congress in last month’s $1.7 trillion omnibus bill lifted a Covid-era ban on states that prevented them from removing people from the health care program.

But in what Medicaid experts see as a positive step, lawmakers put in place several requirements states must meet before removing recipients. They also opted to gradually sunset the roughly $90 billion in federal Medicaid funding states have been receiving the last two years instead of simply shutting it off. Experts agree that these provisions will lead to less people losing coverage by mistake and will ease the pressure on states to quickly remove people from the rolls.

In the early days of the pandemic, Congress passed a coronavirus relief bill that prevented states from kicking people off Medicaid. To help pay the cost for states, the bill increased the federal government’s share of Medicaid, known as the Federal Medical Assistance Percentage, or FMAP, by 6.2%.

Both the ban and additional funding were set to end when the Covid-19 public health emergency was lifted. Instead, it has continually been extended, most recently in November until Jan. 11. This has left states unsure of when they will have to take on the mammoth task of reevaluating who among the 90.6 million people on Medicaid will still be eligible for the program.

“There’s been a lot of uncertainty about how long this will be in place,” said Robin Rudowitz, vice president of the Kaiser Family Foundation and director of the health policy organization’s Program on Medicaid and the Uninsured. “It’s been hard for states to plan, not knowing exactly what the end time is.”  

The federal spending law now answers that question. Starting April 1, Medicaid offices will have to begin determining who on the rolls is eligible. 

“Getting a set date is really helpful. It gets us out of this kind of guessing around the future of the public health emergency,” said Jack Rollins, director of federal policy for the National Association of Medicaid Directors. “That allows states to begin making real concrete plans around what operationally needs to happen in advance of that date and after that date.”

Rollins says Medicaid directors are waiting for the Centers for Medicare & Medicaid Services to issue specific guidance on implementing the requirements in the federal spending law, like whether states have to give recipients 60 days notice before removing them from the program. The law does require states to make a “good faith effort” to reach people, including reaching out in a way other than by mail to let them know they have to reapply before kicking them off of Medicaid.

Determining eligibility can be complicated for a number of reasons. Medicaid officials and health experts acknowledge that notices asking people to verify their income and other information can get lost in the mail. Addresses and phone numbers for enrollees can be out of date. There can also be language barriers. 

Black and Latino enrollees are particularly at risk of having a difficult time with the process, according to an Urban Institute report, which looked at the plans of 11 states. They are more likely to lose housing, leading to address and phone number changes that can cause difficulties reaching them.

If states do not make a good faith effort to notify recipients of the need to re-enroll, the U.S. Department of Health and Human Services can require states to submit a plan to come into compliance. If a state does not submit a plan, the department can forbid them from removing people from Medicaid and can fine them $100,000 for every day they are not in compliance.

“This basically stops a state from saying, ‘Oh, I got this piece of returned mail. I’m just going to send out a termination notice,'” said Rudowitz.

The federal spending law will also gradually sunset the roughly $90 billion a year in increased federal Medicaid funding states have been receiving. Instead of it coming to a screeching halt, the federal government will continue to pick up the additional 6.2% of the cost through March 31. The additional aid will drop to 5% in the quarter that ends June 30, to 2.5% in the quarter that ends Sept. 30, and then to 1.5% through the end of the year.

Not ending the federal aid in April could lead some states to take the full year to reevaluate all Medicaid recipients, said Tricia Brooks, a professor at the Georgetown University Center for Children and Families. “It does provide an incentive for states to not barrel ahead too quickly.”

The problem with “front-loading” or moving quickly, according to Brooks, is that those state’s Medicaid offices will be overloaded at a time when they are already short-staffed.  According to the National Association of Medicaid Directors, 1 in 4 state Medicaid agencies have more than 20% of their positions unfilled.

Another reason not to rush is that states could lose the additional federal funding if they fail to meet reporting requirements. Under the law, states will have to submit monthly reports to HHS beginning in April with information like how many people were renewed, how many were dropped, and how many were able to get health care coverage through the subsidized Affordable Care Act insurance. Should they not file a report, a state could lose as much as one percentage point of their enhanced FMAP. 

Brooks surveyed state Medicaid directors’ plans for the reevaluations with the Kaiser 

Family Foundation last January. The survey had found that 41 states were planning to complete their reevaluations in nine to 12 months. But other states were planning to move more quickly. Texas, for example, has been compiling a list of people who are no longer eligible, and will likely move quickly to get them off of the rolls once they can on April 1. And Arkansas has a law that requires the state’s Medicaid program to complete the reevaluations and return to normal operations within six months.

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PHE; MCOS- JPM23: Centene gears up for Medicaid redeterminations to begin

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: Centene is ready to help make sure revenues transition seamlessly from Medicaid rate cells to ACA rate cells on the exchange.

 
 

 
 

Clipped from: https://www.fiercehealthcare.com/payers/jpm23-centene-gears-medicaid-redeterminations-begin-spring

 
 

SAN FRANCISCO—States now finally have a timeline for when Medicaid redeterminations, which were paused during the COVID-19 pandemic, can resume.

Centene, a major player in Medicaid managed care, is gearing up to assist in this endeavor, executives said Monday during a J.P. Morgan Healthcare Conference session. CEO Sarah London said that because the timetable for the COVID public health emergency was nebulous, many state agencies have had a year to think about their strategy around redeterminations.

Thanks to the recently passed omnibus bill, states know they now can begin redeterminations April 1 even if the public health emergency remains in effect. London said that 88% of the states Centene works with believe they’ll need at least 10 months to complete the redeterminations.

But the extra planning time has afforded states the ability to design a plan to avoid too much “member abrasion,” she said.

“One of the benefits of the fact that we were all preparing for redeterminations at this time last year is that it has allowed a year to think about the right administrative approach,” London said.

She added that the omnibus bill also enables Medicaid managed care plans to assist states more effectively in member outreach, which can also ease the landing for them if they lose Medicaid coverage.

Many in the industry have sounded the alarm about the potential for the redetermination process to boot significant numbers of people off of their health coverage. A report released last month by Urban Institute, a left-leaning think tank, estimated that 18 million people could lose Medicaid coverage because of the redeterminations.

While that figure is bleak, the individual market does offer an opportunity to catch some of the people who may be forced out of the Medicaid program. Enhanced premium subsidies for exchange plans were extended for several years, making coverage more affordable for a broader swath of people.

London said that the enhanced subsidies also offered a path to reach people who have been chronically uninsured and would likely never otherwise have signed up for an Affordable Care Act exchange plan.

“The marketplace subsidies taught the industry where to find those members,” she said.

Enrollment in exchange plans has skyrocketed to record highs over the past two years, thanks in large part to the enhanced subsidies as well as rolling special enrollment windows that have captured more people.

However, as enrollment increases, the Biden administration has looked to push insurers to offer more standardized coverage options, which can make it easier for consumers to select a plan.

London said Centene has rolled out multiple new product designs on the exchanges in the past year and that it’s clear what works for one consumer may not work for another.

“I think limiting product design for something that is hyper-standardized is not good for consumers in the long term,” she said.

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AK- Average wait time 90 to 120 days for state to process Medicaid applications

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: Alaska may be pulling a Missouri.

 
 

 
 

Clipped from: https://www.wrangellsentinel.com/story/2023/01/11/news/average-wait-time-90-to-120-days-for-state-to-process-medicaid-applications/11310.html

Alaska has violated state and federal law by failing to process Medicaid applications in a timely manner, according to an Anchorage-based civil rights law firm that settled a class-action lawsuit in federal court with the state three years ago.

The Alaska Department of Health’s figures last week showed that there are 8,987 outstanding Medicaid recertifications and applications to be processed by the state Division of Public Assistance, which is contending with a major backlog in application processing that officials attributed to a staffing shortage and other issues.

“This number includ…