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Montana’s plan to end continuous Medicaid coverage sparks objections

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MT lawmakers want to increase the frequency of eligibility determinations to reduce spending on ineligible members, but some advocates say the disruption to care is not worth it.


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.


HELENA — Some Montana Medicaid recipients are pushing back against plans to end 12-month continuous coverage for certain people enrolled in public health insurance programs as the state’s public comment period on the new policy draws to a close. If successful, the change would likely alter two Medicaid programs in Montana in significant ways, both for enrollees who rely on the state for health care coverage and for officials tasked with operating the new system.

The state will stop accepting public comment on its proposals on Aug. 31.

While the state Department of Public Health and Human Services estimates that ending continuous eligibility, or a year of uninterrupted health care coverage, will save the federal and state governments roughly $22 million a year in the cost of benefits, critics say the change could result in temporary lapses in coverage for more than 20,000 people in a given year. 

Inherent to opponents’ concerns is the prospect of Montanans losing coverage because of paperwork, communication and bureaucratic errors rather than true income ineligibility, an outcome DPHHS has said it would make every effort to avoid. 

“I’m still unclear as to what the outcome is that the department hopes to seek. But I am pretty sure that, whether intended or not, the outcome will be a reduction in the rolls.”

Rep. Mary Caferro, D-Helena

The department contends that checking eligibility on a more frequent basis will help ensure that people who don’t qualify for the public program won’t remain on the rolls, saving the state money in the process.

But vagueness about what might replace the state’s current system has sparked anxiety among some residents insured by the impacted programs, including single adults with incomes below 138% of the federal poverty level and people diagnosed with a serious disabling mental illness (SDMI). 

“I depend on Medicaid for my mental health problems, and when I have my medicine I feel normal. Please don’t make me worry about going without my medicine,” said one man in a written comment submitted to the department through the nonprofit Montana Women Vote. “Do not end continuous eligibility.”

Montana Free Press is not publishing the names of quoted commenters, who did not respond to interview requests, in order to protect personal medical information. Montana Women Vote estimated it has helped submit roughly 175 comments from individuals in the past month.

Another woman wrote to the department out of concern for her goddaughter, saying it would be “unfair and cruel to end continuous eligibility,” and that the change would make it “difficult or impossible” for her goddaughter to maintain health care coverage.

One recipient told state health officials he depended on Medicaid for “life saving” medicine for diabetes, and urged them not to alter the program’s verification process.

“Please don’t do this to the people that depend on this,” he wrote.


Montana and New York are currently the only states that permit continuous eligibility through an agreement with the federal government agency that administers Medicaid and Medicare. Ending continuous eligibility would happen through a waiver submitted to those federal officials, who may accept or reject the proposal. 

The draft waiver changes developed by DPHHS contain no details about what would replace Montana’s current process of vetting eligibility and income once a year. Department staff said deliberations about program logistics will likely continue between federal and state officials after the waivers are submitted.

“We are implementing this waiver change under the direction of the Montana state Legislature. The funding to pay for continuous eligibility was removed from our budget and there was clear language in directing us to pursue this policy.”

Marie Matthews, DPHHS

The department’s move comes in the wake of a legislative session in which lawmakers failed to pass a complex bill, Senate Bill 100, that would have ended continuous eligibility and made several other changes to how Montana verifies Medicaid eligibility.

Late in the session, lawmakers then passed a budget amendment authorizing DPHHS to end continuous eligibility for adults who are covered through the 2015 Medicaid expansion program. That group includes single adults whose income is up to 138% of the federal poverty level. Nearly 10% of Montana’s total population, or 101,484 enrollees, were covered by Medicaid expansion as of this July.

“We are implementing this waiver change under the direction of the Montana state Legislature,” DPHHS Medicaid and Health Services branch manager Marie Matthews said in an August hearing before lawmakers. “The funding to pay for continuous eligibility was removed from our budget and there was clear language in directing us to pursue this policy.”

Though not instructed to do so by the state Legislature, DPHHS has said it will also submit a waiver amendment to the federal government to end continuous eligibility for roughly 20,000 Montanans covered by the WASP (Waiver for Additional Services and Populations) program, which insures low-income families and caretakers as well as people 18 and older who are diagnosed with a serious disabling mental illness (SDMI). The department has said its reason for doing so is to avoid “significant additional administrative burden” if the state continues 12-month continuous eligibility in one program and not the other.

During the August meeting, department officials stressed that a person would be removed from the program only after verification that their permanent monthly income level has exceeded the eligible amount.

“If somebody makes enough income that they’re no longer eligible for Medicaid coverage, then the next tier is the subsidized [Affordable Care Act] plans on the exchange,” said DPHHS Director Adam Meier, who added that he would expect some residents’ health outcomes to eventually improve after leaving Medicaid, based on a presumption that they will have a larger income.  

“I would think that as people improve their economic situations, as they’re making more income, that would then be their impetus for no longer qualifying [for Medicaid], then we may see a corresponding increase or improvement in health outcomes,” Meier said.


None of the members of the public who testified before lawmakers in August voiced support for the proposed DPHHS waivers. 

Asked how many public comments the department had received so far, and whether those comments supported or opposed the proposals, a DPHHS spokesperson told MTFP that information will be available after public comment closes on Aug. 31 and the department has submitted its proposals to the federal government. 

Democratic lawmakers on the Children, Families, Health, and Human Services Interim Committee in August repeatedly asked members of the department to explain what they consider the benefits of discontinuing continuous eligibility, and how many people would likely be impacted by the change. 

“There’s lots of research that basically shows that by providing people more stable coverage, they end up being healthier. They are able to get primary and preventive care so that they don’t have a diabetic coma, so that if they have asthma, they don’t end up in the emergency room.”

Dr. Leighton Ku, Director of the Center for Health Policy Research at George Washington University

“I’m still unclear as to what the outcome is that the department hopes to seek,” said Rep. Mary Caferro, D-Helena. “But I am pretty sure that, whether intended or not, the outcome will be a reduction in the rolls.”

The department, citing a 2013 study conducted by researchers from George Washington University, estimated that ending continuous eligibility would reduce months of coverage by 2.6%. Caferro said that calculation seems to use “sterile language” to avoid accounting for the impact on real Montanans.

“You know, when you say 2.6% of whatever, we’re talking about people,” she said. “WASP, for example, covers people who are seriously mentally ill and also the families who live in extreme poverty … we are talking about people’s health care and people’s lives.”

Pinpointing the number of people affected by the waiver change is difficult, said Dr. Leighton Ku of George Washington University, one of the researchers whose work DPHHS cited in its estimate of reduced coverage. 

In a written comment submitted to the department and in a later phone interview, Ku said a reduction of 2.6% covered months would likely be distributed across enrollees who would temporarily lose coverage for a short amount of time within a year. If enrollees had their coverage discontinued for roughly two months before they could re-enter the program, Ku said, the number of affected residents could reach as high as 15.6%, or roughly 21,500 people.

Ku said that “churn,” the process of people exiting public programs only to re-apply a short time later, can also create administrative strain on public health departments, on top of the increased vetting and communication demands on state employees. In its proposed waiver changes, DPHHS does not estimate the anticipated costs of running the program with more frequent eligibility checks.

If people fall through the cracks because of miscommunication with DPHHS about their income and eligibility, Ku said, their health care may also be more expensive when they come back to a public health insurance program. More importantly, he said, interrupted health care could have serious repercussions for some individuals.

“If you have diabetes, for example, that means that actually you want your insulin and your medications all year round,” Ku said. “You don’t want to say, OK, insulin for 10 months, two months I’ll go without. That’s how you end up having problems. Like you go into diabetic coma.”

Nationally, health care researchers have encouraged states to enact continuous eligibility policies for particularly vulnerable people with public insurance, such as children, because of improved long-term health outcomes. Ku said he and others are suggesting that states apply that perspective to their Medicaid policies for adults as well. 

“There’s lots of research that basically shows that by providing people more stable coverage, they end up being healthier. They are able to get primary and preventive care so that they don’t have a diabetic coma, so that if they have asthma, they don’t end up in the emergency room,” Ku said. “If there is someone who has, you know, a mental health problem, that they don’t go off their medications, they can still get counseling, so they don’t have a psychotic attack.”

After the close of public comment next Tuesday, DPHHS has until Sept. 3 to apply changes to the proposed waivers and submit them to the federal government. Before any waivers are approved, federal officials will open another 30-day public comment period and could enter negotiations with state officials on the details of proposed plans.

One other logistical reality hangs over Montana and other states looking to change their enrollment and eligibility processes for Medicaid. Given the federally declared public health emergency in place because of the COVID-19 pandemic, states must keep continuous eligibility in place or risk losing an enhanced federal match rate for Medicaid. 

In its presentations on the topic, DPHHS has said it will continue to follow the federal pandemic guideline so as not to sacrifice that boosted rate. The department has said the federal emergency declaration is expected to continue until Dec. 31, and could possibly be extended further, likely pushing the implementation of any changes to Montana’s Medicaid programs into 2022.

by Eric Dietrich 08.23.202108.23.2021


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Iowa in ‘uncharted territory’ as Medicaid numbers swell

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Iowa’s enrollment in traditional Medicaid has surged 16% while enrollment by the expansion population has surged 30%.


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.


COVID pandemic fuels surge in sign-ups for health insurance program



A stethoscope sits on an examination table in an exam room. (Bloomberg News)

DES MOINES — Enrollment in Medicaid and Iowa’s related Health and Wellness insurance programs saw double-digit surges in Iowa due to the COVID-19 pandemic, according to data compiled by a state forecasting group.

Since the pandemic hit Iowa in March 2020, Iowa’s regular Medicaid program added 64,134 individuals through last month while an additional 51,669 individuals enrolled in the Health and Wellness program that offers slightly fewer benefits for recipients between the ages of 19 and 64 who are not pregnant and do not earn more than 133 percent of the federal poverty level.

That represented a 15.56 percent increase when comparing July’s 487,193 Medicaid enrollees to the 423,059 enrolled when the pandemic began, said Jess Benson, a senior Legislative Services Agency fiscal analyst who provides data for the state’s Medicaid Forecasting Group.

The increase in the Health and Wellness program was even steeper, jumping 30 percent, from 176,903 participants in March 2020 to 228,572 last month.

Last month’s Medicaid total included 280,905 children, 90,436 adults, 83,231 disabled Iowans and 32,621 elderly residents.

“We’ve never experienced anything like this before so this is kind of uncharted territory for all of us,” Benson said.

The influx of more than 115,000 new enrollees gradually built as Iowans lost their jobs – and their employer-based health insurance – as the pandemic took hold. State officials project Medicaid and the Health and Wellness program will continue to add 3,000 to 7,000 individuals per month through December. At that point, the eligibility parameters may change, lifting a current prohibition on “dis-enrolling” individuals while a federal public health emergency is in effect.

The suspension of program dis-enrollments is a condition for Iowa receiving a 6.2 percent matching fund rate in federal assistance as part of the COVID-19 relief package. That adjustment of nearly $135 million in fiscal 2020 and $275.4 million last fiscal year enabled Iowa’s Medicaid program to amass “huge carry-forward” balances, Benson noted. Those balances are projected at $244 million for fiscal 2021 and $228 million in the current fiscal year that began July 1.

The matching federal funds helped provide some relief to states struggling to afford the increasing pace of sign-ups for Medicaid, a program for low-income and disabled people.

Once the state is allowed to drop individuals who no longer need or qualify for Medicaid, Benson said he expects enrollment will gradually decline by 100,000 or more. He said reviews will take place to remove people who “normally would have fallen off,” but he was not certain the numbers would settle back to the previous levels around 425,000 Medicaid participants.

“It seems like whenever we go through one of these massive expansions, when we pull back we never get back to that level that we were at before,” he said.

Earlier this year, the federal Centers for Medicare and Medicaid Services released data indicating that nearly 9.9 million people enrolled in Medicaid and the Children’s Health Insurance Program between February 2020 and January 2021 because of the COVID-19 pandemic – a 13.9 percent increase nationally. Iowa’s increase at that time was in the 12 percent range.

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MO- Medicaid expansion applications ‘will sit there’ until October, official tells Missouri state workers

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Newly eligible expansion members won’t get their applications processed for another month while the state works on system changes.



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.



JEFFERSON CITY — A Department of Social Services official told employees recently that forms from Missourians seeking health care coverage under Medicaid expansion “will sit there” for nearly two months while the state makes system updates.

“The applications will sit there until we have the eligibility piece in, which will be Oct. 1,” Kim Evans, director of the Family Support Division, told workers in a video obtained by the Post-Dispatch through an open records request.

Despite the planned delay, the Aug. 11 video also indicates the state currently has the ability to enroll new applicants, a departure from a news release sent out the same day by Gov. Mike Parson’s office, which suggested it didn’t.

“Staff will go ahead and do the verifications that are needed on the applications,” Evans said. “But what we will do is, we will not — we will not run a determination. We will not finalize these applications. We will let the system do that on October the first.”

Parson’s news release didn’t mention DSS’ apparent ability to “run a determination” or “finalize” applications prior to Oct. 1.

The recorded message, as well as Parson’s newsrelease, followed a Cole County judge’s Aug. 10 order directing the state not to deny Medicaid applications from individuals eligible under expansion, which 53% of voters supported in an August 2020 referendum.


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CMS extends deadlines for Medicaid redeterminations after COVID-19 public health emergency ends

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States now have 12 months (instead of 6) to conduct re-determination exercises once the PHE is declared over.


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.


Dive Brief:

  • CMS is extending the timeframe states have to complete pending verifications, redeterminations based on changes in circumstances and renewals for Medicaid, the Children’s Health Insurance Program and Basic Health Program beneficiaries after the federal public health emergency for COVID-19 ends, according to a Friday letter from the agency.
  • Due to significantly increased workloads, state health officials will now have 12 months instead of six after the PHE ends to complete those tasks. It doesn’t change the four-month timeframe after the PHE ends that they have to resume the timely processing of all applications, however.
  • The letter also does not confirm when the federal PHE will end, as it has been extended multiple times. CMS will provide additional detailed guidance on the updated policies in the coming months, it said.

Dive Insight:

Enrollment in Medicaid and CHIP has grown to a record high, with more than 81 million beneficiaries. That’s largely due to the Medicaid continuous enrollment requirement tied to pandemic relief legislation that ceased typical churn, according to the letter.

A disruption in operations caused by the pandemic and the continuous enrollment requirement mean states will be faced with high volumes of eligibility and enrollment actions they’ll need to complete after the PHE and flexibilities that came with it end to ensure eligible beneficiaries don’t lose coverage.

States expressed concern that the original six-month timeframe CMS gave in December 2020 to complete growing backlogs would result in a “renewal bulge,” causing greater administrative burden that could be much more manageable within a larger time frame, according to the letter.

Beneficiaries also risk losing coverage if states held to that timeframe are unable to conduct outreach and put in place strategies to make accurate redeterminations and renewals.

The previous guidance also allowed states to avoid completing another redetermination before terminating coverage after the PHE ends if certain conditions are met, including that eligibility actions processed during the PHE were finished within six months of the beneficiary’s termination after the PHE.

But allowing states to avoid “repeat redeterminations” carries the risk that coverage will be terminated for some eligible beneficiaries, and CMS is rescinding that option in the new guidance. 

Under the updated policy, states can’t terminate any person determined eligible for Medicaid during the PHE, including people who failed to respond to requests for information, until the state has completed a redetermination after the PHE ends.

Before taking an adverse action toward any beneficiary, states must complete an additional redetermination that includes checking available information and data sources without contacting the beneficiary and requesting documents to obtain reliable information when eligibility cannot be renewed based on available information, according to the letter.

With the extended timeframe, CMS said states should reassess their risk-based approach to prioritizing pending work and prepare to restore routine operations after the emergency ends. Their risk-based approach should promote continuity of coverage for those eligible and limit delays in processing for those newly eligible or eligible for more comprehensive coverage.

“CMS is available to provide technical assistance to states that are working to complete pending eligibility and enrollment work within the 12-month timeframe, and we remain interested in hearing state feedback and concerns as states plan for and resume routine operations consistent with the expectations outlined in this letter,” the agency said.

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With 13K new members in Central Oregon, Medicaid will carry pandemic lessons

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Oregon is getting ready to begin the disenrollment process for those no longer eligible once the pandemic is declared over, but is hoping to make the application process easier moving forward.

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.

More Oregonians than ever before are using the state’s free health care during the pandemic — but for many, that could change in a few months.

A set of changes to federal law are expiring next year, potentially causing thousands to lose their access to the Oregon Health Plan, the state’s Medicaid program, which provides health and dental benefits to low-income Oregonians.

“Enrollment in (Central Oregon) has grown since the pandemic started. That’s pretty consistent with what’s happening across the state,” said Lindsey Hopper, a vice president with PacificSource who oversaw Medicaid in Central Oregon for much of the pandemic.

In June, there were about 13,000 more people in Deschutes, Jefferson and Crook counties covered by the state’s Medicaid program than there were at the start of the pandemic last March, according to an analysis of Oregon Health Authority data.

As economic turmoil forced hundreds of thousands of layoffs statewide, more people lost their employers’ coverage and couldn’t afford their own, causing a spike in applications last spring.

But most of the increased enrollment comes from a mundane change to the annual renewal process: In the first pandemic relief package from March 2020, Congress asked states to keep Medicaid members on the rolls during the pandemic, even if their incomes rose or they missed their renewal paperwork.

“We think all of those things contribute to what happens to enrollment in the Oregon Health Plan,” Hopper said.

Oregon’s Medicaid enrollment is expected to keep growing to more than 1.4 million next summer, up from around 1.1 million prior to the pandemic.

Despite Central Oregon seeing more than a 20% increase in health plan members compared to before the pandemic, it’s actually been easier for some agencies to help people get covered during the pandemic.

“So our traffic is down, but every person we get stays on (the plan) until the end of the pandemic,” said Sean McAnulty, who supervises a small team of insurance enrollment assisters with Mosaic Medical.

McAnulty’s team helps Central Oregon residents figure out what low- or no-cost health insurance options are available to them.

Now, the continuous enrollment rules have reduced their caseload by about half.

The rules for showing proof of income were also relaxed, and the ability to work through applications over the phone has allowed Mosaic’s team to spend more time helping clients actually use their coverage once they’re enrolled.

“We’re providing a higher level of assistance as we have more time for each case,” McAnulty said. “There’s a lot of navigation after. Getting someone benefits doesn’t mean they end up using them.”

That means doing things like helping members set up their first appointments once they’re covered.

Changes on horizon

Once the pandemic ends — or, at least, the federal government’s public health emergency declaration expires — the pandemic eligibility rules go away.

That means the state will again begin reevaluating the eligibility of those on the plan, and anyone whose income has risen above the Medicaid threshold since they got on the plan or who hasn’t kept up with their paperwork will receive a notice that their coverage could expire.

“Whenever there’s going to be something like this, there’s always going to be people who fall off,” McAnulty said. “This is why we’re here, is to help people navigate that.”

Since the change is dependent on the federal declaration, precise timelines aren’t yet set in stone. Projections from the Oregon Health Authority suggest the declaration will likely expire in January 2022, and re-enrollment eligibility will be determined over the next six months .

An estimated 200,000 members statewide will lose their coverage when rules change. Some of those people will be losing coverage because they’re no longer eligible, such as if they returned to their jobs and now make more than the income requirement.

But many will be part of what Lori Coyner, Oregon’s former Medicaid director, calls the “churn population,” those who frequently are off-and-on with the state’s insurance policy as their incomes fluctuate or they miss their paperwork.

That churn, all but eliminated by the pandemic’s enrollment rules, makes it harder for people to access the health care they might be eligible for.

“We do know that when people stay on, they keep their doctors, they keep their providers, where to get their prescriptions filled and all of that,” Coyner said. “When they drop off and then come back on, they have to re-establish all of that.”

Pandemic’s impact could be here to stay

Coyner’s goal now is to avoid some of those on-and-off relationships by making some of the pandemic’s lessons permanent fixtures of the Oregon Health Plan.

It’s a perfect time: The state’s renegotiating its five-year agreement with the federal government laying out exactly how Medicaid in the state will operate outside of typical federal rules.

Coyner, now a policy advisor heavily involved in designing the agreement, said the state hopes to make permanent the pandemic provisions reducing how often people have to reapply and reducing the amount of financial paperwork they have to submit.

“We learned that it’s much faster for people to apply and get their application in, and then we can do the income verification later instead of having to have them get a check stub right at the front end,” Coyner said.

Those changes to the plan still have to be approved by the federal agency that oversees Medicaid, and wouldn’t be finalized until the new agreement takes effect next summer.

Aside from all the technical hoops temporary rules may have eliminated, the pandemic “shined a light” on disparities in access to care, added Dana Hittle, now the state’s interim Medicaid director.

“For all of the flexibilities, or a good number of the flexibilities, that we were able to put into place because of the pandemic that we want to continue,” Hittle said, “the goal is to make it as easy as possible for people to have access to health care and remove those barriers.”

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Florida Medicaid enrollment tops 4.8 million, surpassing forecast growth


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Florida Medicaid enrollment continues to surge.


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.


The Florida State Capitol buildings (Old Capitol in foreground) in Tallahassee, Florida.  

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(The Center Square) – Florida’s Medicaid enrollment increased by 1% in June with 48,468 low-income residents qualifying for subsidized health care, according to the state’s Agency for Health Care Administration (AHCA).

As of June 30, there were 4,846,412 low-income, elderly and disabled Floridians enrolled in Medicaid, an increase of more than 730,000 since June 2020, AHCA documents in its June enrollment report.

Florida’s economy lost 1.1 million jobs during the peak of the pandemic last spring, hitting a peak unemployment rate of 14.2%.

Medicaid enrollment boosts quickly followed with more than 885,000 qualifying for full coverage between last March and this February, expanding the state’s Medicaid enrollment from 3.9 million to 4.6 million.

Since February, another 250,000 residents have qualified. In December, the Legislature’s Social Services Estimating Conference (SEC) economists forecast 4.588 million Floridians will be enrolled in Medicaid during Fiscal Year 2020 (FY22), which began July 1. That projection has already been eclipsed.

Using an economic forecasting model based on studies of post-pandemic economic recoveries, state economists project it could take 12-15 months to claw back to pre-pandemic employment levels and trim back the state’s Medicaid rolls.

The state’s $100 billion FY22 budget includes about $44 billion in health care spending largely subsidized by federal pandemic assistance, including about $34 billion for Medicaid, up from $31.6 billion the previous year.

June marked the 15th consecutive month in which Medicaid enrollment increased in Florida, the AHCA notes, and also sustained the state’s status as the nation’s leader in enrollment in subsided health insurance plans offered under the Affordable Care Act (ACA).

According to the federal Centers for Medicaid & Medicare Services’ (CMS) June Special Enrollment Period Report, 413,409 Floridians enrolled in plans available under the ACA between Feb. 15 and June 30.

Overall, about 2.3 million Floridians have purchased “Obamacare” policies, nearly 20% of the 8.5 million people nationwide who selected or were automatically re-enrolled in plans during the extended 2021 open-enrollment period, according to CMS.

After the Trump administration halved the yearly open enrollment period from 12 to six weeks in 2020, President Joe Biden signed an executive order in January authorizing a special enrollment period between Feb. 15 and Aug. 15 because of the COVID-19 pandemic.

According to the CMS, 1.5 million people in 36 states nationwide enrolled in ACA plans between Feb. 15 and June 30. Florida’s 413,409 boost accounted for 27% of that increase.

With average premiums through the ACA marketplace dipping by 25% in April with the adoption of American Rescue Plan tax subsidies, the CMS notes that 34% of new enrollees are paying $10 or less per month after tax credits are taken into account.

“When you make coverage affordable, when you make it easy for people to enroll, they will do so,” CMS Administrator Chiquita Brooks-LaSure said. “”The American Rescue Plan has made health coverage more affordable and accessible than ever – and people are signing up.”

In 2014, 983,775 Floridians signed onto the program in its first year. By 2019, 1.9 million Floridians were enrolled.

Florida’s nation-leading ACA insurance exchange enrollment is a product of the state’s growing population of more than 21 million and state lawmakers refusal to expand Medicaid. Florida is one of 12 states that has not done so.

“Let’s be clear – the monthly marketplace numbers show that across the country, there’s a demand for high-quality, low-cost health coverage,” Health & Human Services Secretary Xavier Becerra said. “Whether through expanded Medicaid or the Health Insurance Marketplace, the ACA is working for millions of Americans – and we’re committed to building on this historic progress.”

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Many Louisiana residents may need to renew Medicaid benefits as COVID-19 emergency winds down

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Louisiana HHS officials have now sent the 2nd in a series of letters notifying members they need to submit documentation to maintain their Medicaid coverage.


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.


Louisiana residents who are enrolled in Medicaid may begin receiving letters from the Louisiana Department of Health informing them that their coverage will end when the federal public health emergency declaration for COVID-19 is lifted.

These “preclosure” letters are among the first public-facing steps Medicaid has taken towards a return to normal operations after a year and a half of emergency response.

The federal public health emergency, which underpins that emergency response, is expected to last until at least the end of 2021. But when it does end, the state’s Medicaid office will be faced with a backload of renewals and eligibility checks.

Over the course of the pandemic, the number of Louisiana Medicaid recipients has grown substantially. Emergency programs have supported much of that growth the past year, but the federal government has asked states to begin planning how to wind down emergency measures, which means, in large part, resuming eligibility checks and disenrolling recipients.

Most of Medicaid’s growth has come from the Affordable Care Act’s expansion program, which covers low-income adults.

In March 2020, 483,000 people received Medicaid under the Affordable Care Act’s expansion, and 1.6 million people were enrolled in total. By May 2021, those numbers were 639,000 and 1.9 million respectively — roughly 40 percent of the state’s residents.

That mirrors a national trend. According to a report released this week by the Centers for Medicare & Medicaid Services, fully a quarter of the U.S. population is now enrolled in Medicaid.

That rise comes partly because of job losses caused by the pandemic, and partly because over the course of the pandemic, Louisiana, like every other state, has virtually halted all Medicaid disenrollments.

That’s important because under normal circumstances, recipients would be subject to regular eligibility checks.

Those eligibility checks happen in several ways: On the most basic level, Medicaid recipients need to renew their coverage every year, either online or over the phone.

But Louisiana conducts the extra step of quarterly wage checks to determine whether someone has exceeded income limits over the course of the year. The checks are automated using a Louisiana Workforce Commission database, and when someone does not pass a check, they receive a letter asking them to provide more information or contest the decision.

The eligibility checks and renewals have been paused by a federal policy related to pandemic Medicaid funding. The cost of Medicaid is split between the state and the federal government, and during the pandemic, the federal government has paid for a larger share. The agreement required states to maintain their Medicaid rolls, with a few narrow exceptions for those who died or moved out of state. That will soon be coming to an end.

In December, the federal government asked states to begin planning for renewed eligibility checks. That guidance was released under the Trump administration, and according to a statement provided by Medicaid to the Lens, “we are prepared with an operational plan. Additional guidance from [the Centers for Medicare & Medicaid Services] is forthcoming.”


Many of the people who are disenrolled may in fact no longer be eligible for Medicaid benefits. But the return to eligibility checks also creates the risk of disenrolling people who are eligible, a phenomenon known as “churn.”

Churn, in which eligible people repeatedly lose and reapply for coverage because of administrative procedures, predates the pandemic, said Stacey Roussell, the policy director of the Louisiana Budget Project, a left-leaning policy think tank.

“What you find in the income level of people who qualify for the Medicaid expansion is, it’s very common throughout the year to have fluctuations in income,” Roussell says. “There are parts of the year where maybe their household need is greater, and they’re going to pick up extra shifts.”

So even though a household may qualify for Medicaid on the basis of its annual income, a quarterly wage check may flag a seasonal fluctuation — like the spring tourist season — as a reason to end eligibility. When that happens, Medicaid sends the recipient a letter asking for more information.

But the recipient has only 10 days to respond, starting from the date the letter was mailed. That tight window, according to an April policy brief from the U.S. Department of Health and Human Services, “rais[es] concerns about the limited time allowed to gather appropriate documentation.”

LDH has published similar conclusions: a 2019 report to the state legislature found that 85 percent of Medicaid eligibility cases were closed because a recipient failed to respond to a request for information.

“These closures do not necessarily indicate ineligibility for Medicaid benefits, and individuals may return to eligibility if supporting information is provided,” the report reads.

The HHS policy brief also noted that churn may lead to higher per-patient Medicaid costs, both because recipients with sporadic coverage are less likely to seek preventative care, which is generally less expensive than emergency care, and because disenrolling and re-enrolling recipients creates high administrative costs for states.

Louisiana enrollees will have months before the end of the pandemic to respond to or contest Medicaid’s inquiries. Still, proving eligibility can present its own challenges, especially for people who may have lost shift work because of the pandemic.

160,000 facing end of benefits

In a December report produced by the legislature’s Joint Medicaid Oversight Committee, LDH estimated that 160,000 people would become ineligible as a result of reinstating eligibility checks. That’s more than the total growth during the pandemic to that point.

However, said Courtney Foster, the Louisiana Budget Project’s Medicaid policy advocate, “we have some issues with this number, because they estimate based on the number of people disenrolled at prior [quarterly wage checks]… [which] does not automatically mean they were ineligible. The number could set an expectation from the legislature or others that they should expect at least that number of people to be disenrolled immediately when the [Public Health Emergency] ends.”

“We want to make sure that, post COVID, as people have delayed care, that they’re as connected to the available health insurance as possible, or else I think we will see an increase in medical debt, or showing up in emergency rooms in need of care that they’ve forgone because they didn’t have health insurance,” said Roussell. “There’s a lot at stake going into 2022 and getting it right.”

A January report from the Commonwealth Fund warned that “erroneous disenrollment could affect tens of millions of Medicaid enrollees” across the country.

In the December report, LDH says that it expects an “overwhelming workload of over 500,000 tasks that are anticipated at the end of the [Public Health Emergency].” In that report, LDH expected to complete the transition process by six months after the end of the public health emergency.

That began with letters sent out in January to those who were up for renewal, “asking them to renew their coverage or to supply additional information,” according to a statement attributed to Medicaid provided by LDH spokesman Kevin Litten. 

The letters sent this month are a follow up to those initial communications.

Starting this month, if members do not respond to these letters, they will lose their coverage when the public health emergency ends,” according to the Medicaid statement Litten provided. “At the end of the public health emergency, members will receive one final letter alerting them to their final date of health care coverage.”

There are steps that the state could take to soften the blow. One of them, expanding Medicaid coverage for people who have just given birth using funding from the American Rescue Plan, died in the 2021 legislative session. It’s also unclear how the legislature’s decision to set the Medicaid budget $24 million below Gov. John Bel Edwards’ original budget proposal will impact recipients. 

Roussell said that her organization’s goal is to see the process slow down and focus on people who still need coverage.

“If you’re entering into it just to say, ‘we must get everybody who is ineligible off the rolls as fast as possible,’ then you’re willing to sacrifice a huge number of people who may still be eligible,” she said. “We want to say, let’s first make sure that everybody has the best chance possible to show that they’re eligible.”


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Medicaid boasts record enrollment, but a purge is coming

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As much as 25% of Medicaid enrollees could be dropped if states follow re-determination rules once the PHE is declared over.

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.

with Alexandra Ellerbeck

Load Error

Nearly 1 in 4 Americans are now on Medicaid — the largest population since the program was first created in 1965.

But millions, or even tens of millions, could get booted from the program next year, as states restart eligibility checks after a forced hiatus.

State Medicaid programs face a looming challenge.

Once the nation’s public health emergency ends — likely at the end of the year — states will be responsible for going through their Medicaid rolls and determining who is and isn’t eligible for the health insurance program for the low income.

It’s normally a task states perform throughout the year, but they were banned from doing so during the pandemic, as a condition of extra federal dollars to help cover an expected surge in Medicaid enrollments. As we explained previously, states got extra money to help cover ballooning Medicaid costs, but in return they had to promise to not remove anyone from their rolls until the federal government concludes the public health emergency.

All at once — probably starting in January 2022 — states will be under pressure to determine eligibility for their entire Medicaid population. Of course, some people will be appropriately removed from the rolls because they’ve gotten a job, a raise or more work hours, making them no longer eligible. 

But there will also be enrollment terminations because of out-of-date enrollee contact information or administrative error. And that’s what Medicaid advocates are worried about. It’s not uncommon during eligibility determinations for states to lose up to 25 percent of their enrollees, said Eliot Fishman, a Medicaid expert at the advocacy group Families USA.

“If this goes poorly you could see at least 20 million or maybe more people lose coverage because of administrative problems,” Fishman told me.

“It’s an eye-popping number, so it’s clearly going to be a huge priority for states and the Biden administration,” he added.

© Win Mcnamee/Getty Images Rep. Lloyd Doggett (D-Tex.) speaks during a news conference last week about Medicaid expansion. (Win McNamee/Getty Images)

It’s a challenge to keep in mind even as the Biden administration celebrates the Medicaid enrollments.

Chiquita Brooks-LaSure, administrator of the Centers for Medicare and Medicaid Services, praised the safety-net program and the insurance it provided to Americans during the economic upheaval wrought by the pandemic and subsequent lockdowns.

Between February 2020 through this past January, enrollment climbed by 9.7 million to reach nearly 75 million nationwide, according to a report released yesterday by CMS. That’s an aggressive growth curve, which now means Medicaid insures more Americans than any other health-care program or insurer.

Larry Levitt, senior vice president at the Kaiser Family Foundation:

“Taken together, the 15 percent spike means the size of the public insurance program for low-income Americans now significantly eclipses the nearly 63 million older Americans covered last year through Medicare,” my colleague Amy Goldstein writes. “Both health insurance programs date to the mid-1960s and were pillars of Lyndon B. Johnson’s ‘Great Society’ anti-poverty strategies.”

“We’ve really seen how important Medicaid is to ensuring the overall health of our country and have seen this through the pandemic,” Brooks-LaSure said.

“We are seeing what a lifeline the Medicaid program is to so, so many Americans,” she told Amy.

© Caroline Brehman/CQ-Roll Call/Getty Images CMS Administrator Chiquita Brooks-LaSure testifies before the Senate Finance Committee in April. (Caroline Brehman/CQ Roll Call/Getty Images)

The administration hinted it’s thinking about the massive, upcoming eligibility determination process.

The process will be messy for states. By the time they restart eligibility checks, it will have been suspended for nearly two years. Many people on the rolls may have moved, making it hard to get in touch with them. And normally states check eligibility throughout the year; they’re not equipped to check the whole population all at once.

Perhaps tellingly, the administration is working on new regulations around the process, according to a list of work-in-process agency rules posted yesterday by the White House Office of Management and Budget. One of the rules is related to “streamlining the Medicaid and CHIP application, eligibility determination, enrollment and renewal processes.”

Fishman said the rule could beef up regulation for how much effort states must expend to get in touch with people, such as requiring them to use cellphone numbers instead of just hard-copy mail.

He said officials might be “realizing if they don’t really get out in front of the end of the public health emergency, they are going to lose a ton of people.”

Additionally, Brooks-LaSure said CMS is working to make sure states handle reviews properly.

“We are very focused on making sure we don’t lose our gains in coverage through unnecessary hoops,” she said yesterday.

She stressed the effort the administration is putting forth to ensure people eligible for government health insurance or subsidies get access to it — including the marketplace plans sold on That coverage is popular among people who earn too much to be on Medicaid but little enough that they qualify for a range of subsidies to buy private coverage.

Brooks-LaSure said that in the past “a lot of people are lost between that transition” from the public insurance to Affordable Care Act health plans. “We should be getting whatever coverage they’re eligible for,” she said.

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Health insurers capitalize on pandemic-fueled Medicaid growth

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36M of the now 80M Medicaid enrollees are in one of 6 national plans. Centene alone has 14M of them.


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.



Data: Company filings, CMS, Kaiser Family Foundation; Chart: Michelle McGhee/Axios

National Medicaid enrollment hit a record 80.5 million this past January, as Congress provided extra funding for states to retain and sign up more low-income adults and children during the coronavirus pandemic.

Between the lines: Because more states have outsourced their Medicaid programs to private health insurers, this pandemic-fueled growth also has been a boon for some of the largest insurance companies.


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State of play: Health insurers have been pursuing more revenue from government health programs, including Medicaid.

  • Seven out of 10 Medicaid enrollees are in a plan run by an insurance company, according to the Kaiser Family Foundation.
  • That would mean roughly 55.5 million of the 80.5 million people now on Medicaid are in a privately run plan.
  • And of those 55.5 million, roughly two-thirds are in a plan owned by six dominant insurance companies.
  • Centene covers 13.6 million Medicaid enrollees, the most of any company. Centene acquired WellCare last year and is now so large, it essentially functions as a branch of state and federal governments.

Worth noting: “The evidence is thin that these contractors improve patient care or save government money,” Chad Terhune reported for Kaiser Health News in 2018.

Go deeper:
Medicaid will be a coronavirus lifeline

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Montana Medicaid Expansion Enrollment Hits Record During Pandemic

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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.


A record number of Montanans are enrolled in the state’s expanded health coverage program for low-income adults. More than 9 percent of the state’s population is enrolled in the program.

Enrollment in Montana’s Medicaid expansion climbed to record levels this spring after rising since early 2020. Nearly 99,000 Montanans were enrolled as of the latest data in April.

The last time enrollment peaked was in the fall of 2018 with 96,656 Montanans enrolled. 


Representative Ed Buttrey from Great Falls is the main architect of the legislation that established and continued expanded Medicaid in Montana. The Republican says the economic slump during the pandemic has spurred enrollment numbers.  

“The program is responding exactly as it should,” Buttrey says. “When we get into hard times, people get into hard times, this is a safety net measure to make sure that folks are not neglecting their health care and that providers are getting paid for the services they provide.”

According to state health department data, since the start of 2020, Sheridan County saw the greatest growth in Medicaid expansion enrollment with a 40% increase. Counties across the state saw on average a 20% growth. 

Chuck Council, a spokesperson for the state health department, says the state stopped disenrolling people from Medicaid programs during the public health emergency and that’s led to the increase. 

Council says the health department will resume taking people off of the programs if they’re no longer eligible once Montana’s public health emergency ends.


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