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State Of Medicaid Enrollment


The Kaiser Family Foundation (KFF) article provides a comprehensive overview of the current state of Medicaid enrollment and the process of unwinding from the continuous enrollment provision that was put in place during the COVID-19 pandemic. This unwinding is a significant transition for Medicaid and has considerable implications for healthcare policy and management.


As of December 1, 2023, there have been at least 11,762,000 Medicaid disenrollments from all 50 states and the District of Columbia. Interestingly, there is a notable discrepancy in renewal outcomes: while 34% of people with a completed renewal were disenrolled, 66% (or 22.2 million enrollees) had their coverage renewed. However, it's important to note that the reported data may undercount the actual number of disenrollments due to varying lags in when states say their data.


The rates of disenrollment vary widely across states, ranging from 64% in Texas and Idaho to just 10% in Illinois and Maine. This variation is attributed to differences in state policies regarding early renewals and renewal procedures, as well as the capacity of their systems. Some states, like Texas and South Carolina, target individuals early in the unwinding period who they believe are no longer eligible or did not respond to renewal requests during the pandemic. Other states are conducting renewals based on an individual's renewal date. Implementing policies and the sophistication of automated eligibility systems also affect how efficiently and accurately renewals are processed.


A significant concern arises from 71% of all disenrollments across states with available data for procedural reasons. In these cases, people are disenrolled because they did not complete the renewal process, often due to outdated contact information or misunderstanding of the renewal packets. This raises concerns as many people who are disenrolled for these reasons may still be eligible for Medicaid coverage. To address this, some states have temporarily paused procedural terminations while they work on improving their renewal processes.


Children represent a significant portion of those affected by these changes. In 21 states reporting age-specific data, children accounted for approximately 38% of Medicaid disenrollments. This amounts to at least 2,195,000 children being disenrolled out of 5,831,000 total disenrollments in these states as of December 1, 2023. The state of Texas, having one of the most extensive Medicaid programs, notably impacts the proportion of children disenrolled.


Regarding the renewals, 59% of the coverage renewals as of December 1, 2023, were conducted on an ex-parte basis, while 41% were through a renewal form. Under federal rules, states are mandated to first attempt administrative (ex parte) renewals using available data sources before requesting documentation from an enrollee. However, the rate of ex parte renewals varies across states.


Finally, the unwinding of the Medicaid continuous enrollment provision, which had halted Medicaid disenrollments since March 2020, ended on March 31, 2023. Due to this provision, Medicaid/CHIP enrollment had peaked at over 94 million in March 2023, an increase of over 22 million from February 2020. As states work through the unwinding process over the next 12 months, millions are expected to lose Medicaid coverage. This will involve redetermining the eligibility of all Medicaid enrollees and disenrolling those who no longer qualify or are unable to complete the renewal process.


This unwinding process represents a significant challenge for states and has substantial implications for Medicaid enrollees, particularly those who might be disenrolled due to procedural issues despite remaining eligible. The variations in state policies and the impact on vulnerable populations, especially children, highlight this shift's complexities and potential consequences. As states navigate this transition, ongoing monitoring and adjustments will be crucial to ensure that those eligible for Medicaid continue receiving the necessary benefits.

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