Medicaid Unwinding Disenrolls Millions, Mostly Due to Procedural Reasons
As of July 27, at least 3.8 million Medicaid beneficiaries in 38 states have been disenrolled from the Medicaid program due to the end of the federal public health emergency, according to KFF, formerly the Kaiser Family Foundation.¹ The process, known as the Medicaid unwinding, was paused for three years during the COVID-19 pandemic to ensure as many people stayed enrolled as possible. Most states have now officially resumed Medicaid redeterminations to determine a person's Medicaid eligibility. The unwinding process is set to continue through May 2024, with the start date for coverage losses varying by state.2
Many are getting caught up in administrative red tape, losing coverage for procedural reasons related to outdated contact information or because they have not notified the state of their updated address, income, or other information. About three out of four beneficiaries who have been disenrolled lost coverage because of procedural issues.1 For this reason, the Centers for Medicare & Medicaid Services has paused coverage redeterminations in several states.3 Most people are still unaware this process is going on. Sixty-five percent of Medicaid enrollees are unaware their states are or will be restarting eligibility redeterminations.4 According to an article published in June by Kaiser Health News, about 4 in 5 people dropped never returned the paperwork or omitted required documents.5 The large number of terminations suggests qualified people are losing their coverage, and three out of 10 people dropped have been children.1
Adding uncertainty to a health system’s bottom line, the impact could mean reduced reimbursement for health providers unless they navigate the administrative issues or find alternative payer coverage for their patients that have been disenrolled from Medicaid. And even though CMS published a guide for states to minimize terminations for procedural reasons,6 it could still be difficult for health systems to adequately prepare for the financial impact of these redeterminations. Combined with inflation, supply chain issues and staffing shortages, many healthcare providers don’t have the people, processes, and technology to handle these procedural issues and make sure patients who qualify for Medicaid stay enrolled.
Having a trusted revenue cycle management partner who specializes in eligibility and enrollment to help patients navigate the Medicaid redetermination process is critical. This should be a partner that provides comprehensive in-house eligibility screening that starts at the patient’s bedside with compassionate advocates who identify and secure any potential programs. An eligibility partner with solid contacts in county government offices and that understands how to escalate cases is important to ensure cases that can affect discharge planning or long-term care placement don’t get lost in the mix.
About Elevate Patient Financial Solutions®
Elevate Patient Financial Solutions® is a proven revenue cycle management partner that provides a range of services, including Medicaid Eligibility & Enrollment, Complex Claims, A/R Services and Self-Pay. Our Medicaid Eligibility & Enrollment services help patients enroll in available coverage programs, including Medicaid, to help pay for care. Our comprehensive in-house eligibility screening starts at the patient’s bedside with compassionate advocates who identify and secure any potential programs. We work closely with hospitals and healthcare facilities to educate Medicaid enrollees about the renewal process and help patients find other coverage. We also monitor evolving state landscapes regarding eligibility and enrollment operations. ElevatePFS was named a top performer for eligibility and enrollment services in the KLAS “Eligibility & Enrollment Services 2023” report.7
Resources
1. KKF, “Medicaid Enrollment and Unwinding Tracker,” July 27, 2023. https://www.kff.org/medicaid/issue-brief/medicaid-enrollment-and-unwinding-tracker/
2. Center on Budget and Policy Priorities, “Unwinding Watch: Tracking Medicaid Coverage as Pandemic Protections End,” July 25, 2023. https://www.cbpp.org/research/health/unwinding-watch-tracking-medicaid-coverage-as-pandemic-protections-end
3. HealthPayerIntelligence, “Why CMS Paused Medicaid Coverage Redeterminations in 6 States,” Victoria Bailey, July 27, 2023. https://healthpayerintelligence.com/news/why-cms-paused-medicaid-coverage-redeterminations-in-6-states
4. KFF, “The Unwinding of Medicaid Continuous Enrollment: Knowledge and Experiences of Enrolleees,” Ashley Kirzinger, Jennifer Tolbert, Lunna Lopes , Alex Montero , Robin Rudowitz, Kaye Pestaina, and Karen Pollitz, May 24, 2023. https://www.kff.org/medicaid/poll-finding/the-unwinding-of-medicaid-continuous-enrollment-knowledge-and-experiences-of-enrollees/
5. KFF Health News, “Biden Admin Implores States to Slow Medicaid Cuts After More Than 1M Enrollees Dropped,” Hannah Recht, June 13, 2023. https://kffhealthnews.org/news/article/biden-administration-states-medicaid-cuts-million-dropped
6. Medicaid.gov, Section 1902(e)(14)(A) Waivers and Other Strategies, “Strategies to Prevent Procedural Terminations,” 2023. https://www.medicaid.gov/resources-for-states/downloads/state-strategies-to-prevent-procedural-terminations.pdf
7. KLAS Research, “Eligibility and Enrollment Services 2023,” M. Hunt, J. Christensen, S. Howell, April 4, 2023. https://klasresearch.com/report/eligibility-and-enrollment-services-2023-an-initial-look-at-client-satisfaction/3026