Only those who are not eligible will lose their Medicaid

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Notice

By Dr. Joel Zinberg

July 2, 2023 | 4:48 p.m.

Congress ended the requirement for continued Medicaid enrollment on March 31, 2023, and began phasing out enhanced federal Medicaid payments to states during 2023. Getty Images/Win McNamee

Medicaid advocates are calling on the federal government to stop states from withdrawing people from the program after 25 states and the District of Columbia dropped more than 1.5 million enrollees in less than three months.

Activists say most of them are procedural unenrollments due to the state not contacting recipients due to outdated contact information or because the enrollee failed to renew in because of bad instructions from the state.

Yet of those who have been opted out, most will lose Medicaid for one simple reason: they are not eligible, and many are no longer even receiving care through Medicaid, even though taxpayers send millions each month to HMOs. , etc. to cover them.

The unenrollments come after a process of redetermining eligibility resumed after a three-year pandemic pause.

States normally conduct periodic reviews to take into account changes in recipients’ circumstances that may affect their eligibility.

People die, leave the state, get a new job that provides health insurance, or higher income that exceeds Medicaid thresholds.

Or they have changes in their family situation.

Most people who have been opted out will lose Medicaid because they are not eligible for it, according to Zinberg.AP/Alex Slitz

The March 2020 Families First Coronavirus Response Act offered states enhanced Medicaid matching funding (a 6.2% increase) in exchange for ceasing withdrawal of ineligible enrollees during the emergency of public health the continued enrollment condition.

Each state took the money.

Registrations jumped by 23 million people. The increase was not due to increased poverty.

Even as unemployment fell following an early pandemic peak, Medicaid enrollment continued to grow.

Many current enrollees are likely not eligible for Medicaid benefits.

The Medicaids irregular payment rate was already 21%, or $86.5 billion in unspent annual federal spending before the pandemic, and annual reviews have been suspended.

The problem with ineligible beneficiaries is not simply that some people receive health insurance to which they are not entitled.

Approximately 90% of beneficiaries are enrolled in managed care organizations, mostly incomplete managed care organizations that receive payment per member per month for providing services.

States pay monthly premiums for people with duplicate coverage from employer insurance, insurance in another state, or enrollment in a non-group plan or for deceased persons.

Insurers receive payments for beneficiaries who will never use the services.

This does not preserve resources for legitimate recipients of Medicaid or other state priorities.

It also wastes the federal dollars that fund most Medicaid spending.

Congress ended the continuous enrollment requirement on March 31, 2023, and began phasing out enhanced federal Medicaid payments to states during 2023.

States have up to 12 months to initiate, and 14 months to complete, a renewal (or opt-out for those deemed ineligible) for all Medicaid enrollees.

The Urban Institute estimates that nearly 18 million people could be removed from the lists.

Some states, anxious to put an end to unnecessary spending, have prepared.

In a recent Paragon Health Institute program, officials from Arkansas and Iowa described multi-year programs to update addresses and other enrollee information and alert providers and registrants that redeterminations of eligibility were forthcoming.

Both states have begun redeterminations focused on those likely ineligible and have begun deregistrations.

Other states seem less concerned.

Activists say most procedural unenrollments are due to the state not contacting recipients due to outdated contact information or the enrollee not completing a renewal.Getty Images for SEIU Care Campaign

Oregon will not begin removing anyone until October 1.

While Florida has already unsubscribed 303,000, New York won’t begin unsubscribing until July.

Advocacy groups and the Center for Medicare and Medicaid Services say most coverage losses are due to states’ inability to contact enrollees or enrollees’ difficulty navigating the renewal process.

These administrative problems are probably minimal.

The Kaiser Family Foundation reported that all states are now updating enrollee contact information and instituting new administrative measures to reduce erroneous Medicaid terminations.

Officials in Iowa and Arkansas reported that the main reason people don’t respond to renewal requests is because they already have other insurance coverage.

Florida officials told my Paragon colleagues that most nonresponders have not used any Medicaid services in the past year.

Almost everyone who is no longer eligible for Medicaid will be eligible for other coverage through employer plans, subsidized ACA exchange plans, or other out-of-market insurance.

Even those who remain eligible but are removed from coverage in error are unlikely to experience any interruptions in care.

Beneficiaries are entitled to three months of retroactive coverage if it is later determined that they are eligible.

Hospitals are permitted to assume presumptive eligibility without verifying eligibility information.

Finally, a robust appeal process is in place for renewal denials.

The sky does not fall. In fact, the sky is clearing as unnecessary spending finally stops.

Joel Zinberg is a Senior Fellow at the Competitive Enterprise Institute and Director of Public Health and the American Well-Being Initiative at Paragon Health Institutes.

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