More than two-fifths of the 120,000 Coloradans whose Medicaid coverage was up for renewal in May lost coverage when their eligibility was reviewed for the first time since early 2020 — a result that was in line with what happened before the pandemic.
The Colorado Department of Health Care Policy and Financing reported Wednesday that 56% of people whose eligibility was examined in the first month were able to stay covered by Medicaid, while 42% lost coverage and the rest were still in the process.
The numbers were nearly identical to the 57% and 41% averages from 2018 and 2019, when the state last did regular Medicaid removals, said Kim Bimestefer, the department’s executive director.
For much of the pandemic, states couldn’t remove most people from Medicaid because of the federal public health emergency. Congress decoupled those two provisions late last year, and states started reassessing eligibility in April. The redeterminations will happen on a rolling basis, with people who signed up in July of a previous year evaluated this month.
One difference is that the percentage of people who were disenrolled because they didn’t return the paperwork was higher than it was before the pandemic, Bimestefer said. About 26% didn’t return the paperwork in May, compared to an average of 12% in 2018 and 2019.
It’s not clear how many of those people are still eligible and didn’t understand that they need to return paperwork to keep their coverage, versus the number who got jobs that offered them health insurance and didn’t respond because they no longer need Medicaid, Bimestefer said. If people no longer need coverage, it would be helpful if they reported that fact to the state, so that workers doing outreach know they don’t need to call those members, she said.
“We don’t want to waste precious resources on those who already have coverage,” she said.
Earlier this year, the department estimated 325,000 people in Colorado may lose insurance because their incomes rose too much to qualify for Medicaid, they moved out of state, or they exhausted their year of postpartum coverage. About 53,000 people lost coverage in the first month or re-evaluations.
Some people who ignored the initial messages likely will sign up again later this year, after they learn they were disenrolled, Bimestefer said. While it’s better not to have a gap in coverage, those who discover they’ve become uninsured when they seek care can fill out an application the same day, which will cover them retroactively to the day it was filed if they’re still eligible, she said.
About 1.7 million people in Colorado were enrolled in Medicaid as of May, an increase of about 500,000 compared to before the pandemic. Enrollment also surged nationwide, with about 23.3 million more people covered by Medicaid and/or the Children’s Health Insurance Program in March 2023 than in February 2020.
The first month of redetermination went about as expected, but the state is going to examine its data and hold focus groups to see if any tweaks could improve outcomes, Bimestefer said. Individuals can help by updating their contact information on the state’s website and looking into their options for coverage, she said. Even if the adult members of a household no longer qualify because their income went up, children could still be eligible for Child Health Plan Plus.
“It’s where we thought (the numbers would be), but it’s not where we want,” she said.
“A more difficult process” than anyone wanted
In early March, the Kaiser Family Foundation estimated between 5.3 million and 14.2 million people could lose coverage under Medicaid or CHIP over the next year. Nationwide, more than 1 million people have lost coverage so far.
Scam artists have seen an opportunity in the efforts to keep people enrolled, calling or texting with threats that people’s health insurance will be canceled if they don’t hand over money or personal information. The state Medicaid agency won’t ask for your Social Security number or banking or credit card information over the phone.
Gretchen McGinnis, senior vice president of health care systems and accountable care for Colorado Access, said about 25,000 fewer people were covered by Medicaid in their area at the start of June than at the beginning of May. Colorado Access manages care for about 600,000 Medicaid recipients in Denver, Adams, Arapahoe, Douglas and Elbert counties.
It’s not clear how many of those people are no longer eligible because they left the state or earn too much, McGinnis said. It’s also possible some moved to a county and were counted under a different organization. The management organizations and the department are working to improve data collection so they can better track where members ended up, she said.
McGinnis estimated they have successfully contacted about 37,000 households, though she couldn’t say how many they haven’t been able to reach. Community organizations and health care providers are also reaching out, she said.
“Our hope is that (members) receive multiple types of communication that keeps this issue at the front of their minds,” she said.
Patrick Gordon, CEO of Rocky Mountain Health Plans, said that the company manages Medicaid coverage for about 255,000 people in western Colorado. While reassessing eligibility was a regular practice before the pandemic, it will be more challenging now, since newer recipients have never gone through the process and may not understand what they need to prove, he said.
“We’ve never done this before. No one has,” he said.
In May, the process of automatically verifying eligibility seemed to be going smoothly, Gordon said. When they can’t determine that someone qualifies by looking at other data the state collected, they mail a renewal packet, and try other methods of communication if the packet is undeliverable, he said.
The state planned for this for some time and, so far, there haven’t been any major surprises, Gordon said. Unfortunately, however, it seems many people still aren’t aware they need to update their contact information with the state and take other steps to stay covered, he said.
“We want to make sure, a year from now, we don’t have people struggling with unpaid medical bills,” he said.
McGinnis said proving eligibility for public assistance programs has always been a relatively “clunky” experience when compared to most things people do online. What makes it particularly challenging is the sheer number of people who need to prove eligibility in the next year, she said.
“I think it is a more difficult process than any of us would have preferred to see happen,” she said.
Most people in Colorado who lose Medicaid coverage would be eligible for subsidized health insurance through the marketplace, though it’s not clear how many will complete the process. About 65% of people disenrolled from Medicaid or CHIP nationwide before the pandemic were uninsured for at least a brief time, and 17% reported they were uninsured for at least one year afterward, according to the Kaiser Family Foundation.
Some people also may return to Medicaid before long, if their household incomes fluctuate. Before the pandemic, about 41% of people disenrolled in Medicaid or CHIP were reenrolled within a year.
Colorado’s cut-off rate was 13th-highest
States are reporting their numbers differently, making comparisons challenging, but there are clear outliers.
South Carolina terminated coverage for more than 80% of the Medicaid recipients whose eligibility it has reviewed so far, while Virginia has ended coverage for only 16%. Eight states reported more than 80% of their disenrollments were for procedural reasons, while only 15% were in Alaska.
The Kaiser Family Foundation compared states and found Colorado’s cut-off rate was the 13th-highest of 24 states that reported their eligibility data. (The foundation estimated 44% of examined Coloradans lost coverage, which was slightly higher than the state’s numbers showed.)
Chiquita Brooks-LaSure, administrator of the federal Centers for Medicare and Medicaid Services, said June 20 that the early numbers are “unfortunate” and urged states to use all available strategies to notify people of the redeterminations and help them to stay enrolled. As of December, about 60% of Medicaid recipients said they’d heard “nothing at all” about the need to confirm their eligibility in the coming months, according to the Robert Wood Johnson Foundation.
“Keeping people covered has been and will continue to be an all-hands-on-deck effort,” she said.
Daniel Tsai, director of the Center for Medicaid and CHIP Services at CMS, said the agency is urging states to take the full allotted year for their redeterminations, to automatically renew coverage when possible and to partner with other community organizations to get the word out. If states don’t follow the rules requiring some effort to reach Medicaid recipients, CMS could request a corrective action plan or even order them to pause redeterminations, he said.
Tsai declined to name a specific threshold at which CMS gets concerned, but said the rate of terminations because people hadn’t returned the paperwork was too high nationwide. It’s possible some people didn’t go through the process because they found other coverage, but focus groups have indicated that most Medicaid recipients don’t understand the process and what they need to do, he said.
“We are urging every state to do everything in its power,” he said.
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