Category Archives: Medicaid Disenrollment

Millions could lose coverage under potential GOP Medicaid policies: CBO

Posted on by • Posted in Congressional Budget Office (CBO), Health Insurance Coverage Adequacy, Health Policy, Medicaid, Medicaid Cuts, Medicaid Disenrollment, Medicaid Eligibility, Preexisting Conditions, Terminated Health Insurance, Underinsured, Uninsured • Leave a comment

https://www.healthcaredive.com/news/medicaid-coverage-losses-gop-policies-cbo/747615/

Dive Brief:

  • Millions of people could lose coverage under potential policy changes to Medicaid under consideration by Republicans in Congress, according to a letter sent to lawmakers this week from the Congressional Budget Office. 
  • One option, reducing the federal government’s share of costs for enrollees covered under Medicaid expansion, would reduce the federal deficit by $710 billion over the next decade. But in 2034, 5.5 million people would be removed from the safety-net program, with 2.4 million of these enrollees becoming uninsured, according to the CBO.
  • Another potential policy, placing a per-enrollee cap on federal spending, would remove 5.8 million people from Medicaid. Nearly 3 million of those people would lose coverage entirely. The policy would reduce the deficit by $682 billion, the analysis found.

Dive Insight: 

Debates surrounding potential cuts to Medicaid — and their implications for patients and providers — have been heating up in Congress for weeks. 

Last month, lawmakers approved a budget resolution that called for the House Energy and Commerce Committee, which oversees Medicare and Medicaid, to find $880 billion in savings. That budget goal is likely impossible to hit without targeting major healthcare programs under the committee’s purview, according to an earlier analysis published in March by the CBO.

The committee is expected to meet next week to mark up its portion of the reconciliation package and hash out legislation.

However, cutting Medicaid is a politically contentious move for Republican lawmakers. Some legislators have pushed back on potential cuts, and others have argued they’ll preserve Medicaid for the most vulnerable by targeting fraud, waste and abuse in the safety-net insurance program. 

But Rep. Frank Pallone Jr., D-N.J., and Sen. Ron Wyden, D-Ore., who requested the latest CBO analysis, said the policies will ultimately limit benefits and result in coverage losses.

“This analysis from the non-partisan, independent CBO is straightforward: the Republican plan for health care means benefit cuts and terminated health insurance for millions of Americans who count on Medicaid,” Wyden said in a statement. “Republicans continue to use smoke and mirrors to try to trick Americans into thinking they aren’t going to hurt anybody when they proceed with this reckless plan, but fighting reality is an uphill battle.”

The letter from the CBO analyzes five potential policy options for Medicaid: setting the federal matching rate for the expansion population at the same rate as other enrollees; limiting state taxes on providers; setting federal caps on spending for the entire Medicaid population or just the expansion group; and repealing two regulations linked to eligibility and enrollment. 

Most of the options reduce the funds available to states, according to the CBO. The agency expects states will replace about half of the reduced support with their own resources, and then reduce spending by cutting provider payment rates, reducing optional benefits and cutting enrollment. 

For example, if Congress decides to limit provider taxes, where states levy taxes that finance a portion of their Medicaid spending, that would result in 8.6 million fewer people enrolled in Medicaid in 2034, including nearly 4 million becoming uninsured. The move would ultimately lessen the federal deficit by $668 billion, as the government would offer reimbursement for lower state spending, the analysis found.

Another option, placing a cap on federal spending for the expansion population, would save $225 billion — but 3.3 million people would lose Medicaid coverage. Repealing regulations that aim to reduce barriers to enrollment and simplify the renewal process would reduce the federal deficit by $162 billion over the next decade, but 2.3 million fewer people would be enrolled in Medicaid, the CBO found.

The Broader Policy Implications of the Medicaid Unwinding Crisis

Posted on by • Posted in ACA, Dept of Health and Human Services (HHS), Health Policy, Medicaid, Medicaid Disenrollment, Medicaid Eligibility, Medicaid Unwinding • Leave a comment
https://www.commonwealthfund.org/blog/2023/broader-policy-implications-medicaid-unwinding-crisis?utm_campaign=Achieving%20Universal%20Coverage&utm_medium=email&_hsmi=284335326&_hsenc=p2ANqtz-9cKTOmNOeC5k4vFsoOsqgWZzPVzmRaP4iPfQkiFjawMrc4xNf2S55E2HQGhxyBBL_nAjQM5_JlMsXS0QFTxGrWRJs1ig&utm_source=alert

November 2023 marks seven months since the federal government began unwinding Medicaid’s pandemic-related continuous enrollment guarantee. Because Medicaid coverage is associated with improved access and better health outcomes, stabilizing enrollment throughout the public health emergency was a vital public health measure. Now states must grapple with the challenge of returning to normal operations, which means reviewing eligibility for more than 90 million beneficiaries. 

By early November, at least 10,135,000 people had been disenrolled. Overall, two-thirds of people had their coverage renewed while about one-third lost eligibility.

The rate of disenrollment during renewal varies greatly, depending on a state’s underlying Medicaid eligibility rules, capacity to process renewals, and strategies for simplifying the process and reducing risks of error. Illinois showed a disenrollment rate of less than 10 percent, while Florida’s rate was one-third. Disenrollment of children appears to be happening at a high rate, even though they should be protected because of the relatively generous eligibility standards governing children’s coverage under Medicaid and the Children’s Health Insurance Program (CHIP).

As of November, children’s enrollment was down by 2.2 million. 

Among those disenrolled, more than 70 percent lost coverage for procedural reasons, like failure to return forms or an inaccurate mailing address. High procedural disenrollments also likely reflect agency error (e.g., miscalculating earnings information), but available data do not track the proportion of procedural disenrollments that result from such mistakes.

The high procedural disenrollment problem is exacerbated by the speed at which some states are acting — far faster than required under the federal 12-month unwinding timeline allowed by Congress. 

Compounding matters, anecdotal evidence suggests that people terminated for procedural reasons are also being turned away from the health insurance marketplace because states close cases without determining if beneficiaries are truly ineligible for Medicaid. This is happening even though marketplaces and Medicaid agencies are supposed to coordinate activities to ensure that people losing Medicaid can obtain marketplace coverage if eligible. 

The numbers are staggering. Texas has disenrolled more than 1.2 million people; Florida’s disenrollments have exceeded 730,000.

Disenrollment rates are the result of a complex process, excessive speed, and overtasked workers, along with states’ underlying eligibility rules for low-income children and adults. If these rules are more restrictive, they increase the disenrollment rate. In states that have not adopted the Affordable Care Act (ACA) expansion, the potential for major coverage loss is far higher. In nonexpansion states, the rules for poor adults (who had coverage throughout the pandemic, including postpartum women or teenage children who have now reached young adulthood) require an extremely low income level — 16 percent of the federal poverty level in Texas or about $4,000 annually for a family of three in 2023. As stated previously, the disenrollment of children has been far higher than expected, affecting even newborns during the first year of life when enrollment is guaranteed. 

The ACA streamlined and simplified Medicaid’s historically complex enrollment and renewal process by eliminating in-person interviews, automating data collection functions, and instituting an ex parte process, in which the state performs reviews without placing unnecessary renewal burdens on beneficiaries. In addition, a historic 1970 Supreme Court decision governing due process protections for people receiving means-tested public assistance benefits requires states to fully and comprehensibly explain in writing why coverage is ending and gives beneficiaries the opportunity to contest a termination decision before it takes effect. These constitutional safeguards are especially crucial to Medicaid because termination implicates not only coverage, but access to health care itself. 

In 2022, long after the ACA simplification reforms were instituted, the U.S. Department of Health and Human Services (HHS) concluded that of the 15 million people estimated to lose Medicaid during the unwinding process, nearly 45 percent would lose coverage because of procedural issues associated with navigating the renewal process. HHS also foresaw that children and younger adults (including very poor parents) would be disproportionately affected. The evidence appears to be bearing both predictions out. 

The federal government and advocates have begun to take action to mitigate erroneous coverage loss. The 2022 unwinding legislation empowers the HHS Secretary to impose corrective action plans in states showing excessive procedural disenrollments. In states that fail to comply with such plans, HHS would “require the State to suspend . . . terminations of eligibility for medical assistance . . . that are for procedural reasons until the State takes appropriate corrective action.” Under this special power, HHS has urged states to guard against improper disenrollments without an individualized ex parte review and also ordered reinstatement of a half-million children and adults disenrolled simply because other family members were no longer eligible. The agency has ordered states to halt disenrollment until corrective action is taken. 

In a first-of-its-kind case, beneficiaries in Florida who have lost coverage without required constitutional protections have sued for reinstatement and to halt further disenrollment. Plaintiffs include children (some with serious disabilities) and adults. The complaint describes state notices that are incomprehensible by people with average education and that fail to convey which family members are losing coverage, why coverage is being lost, and the right to a pre-termination hearing. Beneficiaries in other states may follow suit. 

The current unwinding situation presents a unique challenge for states, health care providers, and above all, millions of beneficiaries who depend on Medicaid. It is important to remember that continuous enrollment enacted during the pandemic was a response to three structural limitations that are part of everyday Medicaid: first, highly restrictive eligibility limits, particularly in states that do not cover low-income working-age adults; second, the lack of annual guaranteed enrollment for all beneficiaries, regardless of age or basis of eligibility; and third, a redetermination process that, despite improvements, continues to face enormous operational challenges.