The Des Moines Register
Nearly 28,000 Iowans have been disenrolled from Medicaid. Here’s why:
Michaela Ramm, Des Moines Register – July 26, 2023
Nearly 28,000 Iowans have been disenrolled from Medicaid this year as part of Iowa’s redetermination process — a consequence of continuous coverage no longer being guaranteed.
The latest data from the state’s Health and Human Services Department shows 27,744 Iowans were disenrolled from the safety net health insurance program since April, when Iowa began “unwinding” expanded eligibility.
About 30% of those Iowans — 8,401 — were disenrolled for procedural reasons, including failing to return paperwork.
The remaining 19,343 were deemed ineligible for further coverage, state data shows.
Since April, the state has been reviewing the eligibility of 900,000 Iowans who receive Medicaid and CHIP (the Children’s Health Insurance Program) benefits to determine if they still qualify under pre-pandemic regulations.
More: Did you lose your Medicaid coverage? Here’s what you need to know.
Federal health officials and other advocates have raised alarms about the number of people disenrolled for procedural reasons, which refers to those who did not return their paperwork or otherwise failed to complete the renewal process.
They say people may not be aware they’re up for renewal or recently changed addresses and didn’t receive the paperwork.
“What we’re seeing across the country from the first two months is that whilst people have done a lot to prepare, at the same time there are a lot of people losing their coverage,” said Dan Tsai, director of the Center for Medicaid and CHIP Services. “A really high number of folks are losing coverage for what we call procedural reasons.”
State officials managing the redetermination process, however, say the current rate of disenrollment, including procedural drop-offs, was expected. Iowa Medicaid Director Liz Matney said the department’s data show the majority of those kicked off the program have health insurance coverage elsewhere.
“It’s not surprising. If somebody gets renewal paperwork and they say they don’t need Medicaid anymore, why would they submit paperwork?” Matney told the Des Moines Register. “So when the team has been looking at the individuals who are disenrolled for any reason, but particularly for those who are disenrolled for not returning their paperwork, we can tell in our system who has other health insurance.”
That data has not been made publicly available on the state’s dashboard.
Still, officials with the Centers for Medicare and Medicaid Services have called on Iowa and other states to simplify the process. In addition to keeping individuals who qualify on Medicaid, states also need to connect low-income residents with other coverage options, Tsai said.
“We’re looking for states to also do everything in their power, way beyond what the federal minimums are, to try to make it easier for eligible people to keep their coverage,” Tsai told the Register. “If you’re not eligible for Medicaid, we want you on your employer-sponsored coverage. We want you on the ACA plans. We don’t want you uninsured, and that’s the bottom-line focus for us from a federal standpoint.”
More: More than 100k Iowans will lose expanded Medicaid soon. What you need to know:
What is Medicaid redetermination?
Typically, Iowans on Medicaid undergo a redetermination process every year to check their eligibility to see whether they still qualify.
But as part of the federal government’s response to the coronavirus pandemic starting in March 2020, states were required to maintain coverage for individuals on Medicaid, even if they no longer qualified. In exchange, states received enhanced federal funding to manage the health insurance program.
In Iowa, more than 168,000 individuals maintained coverage during the three-year pause on Medicaid redeterminations, state data shows.
That requirement to maintain continuous coverage ended in March 2023, when federal officials ended the national public health emergency.
As a result, the state’s health and human services department is checking the eligibility of hundreds of thousands of Iowans on Medicaid and CHIP, a massive undertaking that must be completed by May of 2024. Matney said state employees are processing close to 70,000 new applications every month, a “huge increase” from the typical redetermination process pre-pandemic.
Early estimates showed about 136,000 Iowans would be disenrolled from Iowa Medicaid, the state’s $7 billion privatized program, by the end of the 12-month unwinding period.
The state agency has worked to automate as much as possible and has launched a public messaging campaign to spread the word to members to turn in their paperwork. The managed care organizations that administer Medicaid benefits also have engaged in direct outreach to members, including knocking on the doors of some members to help them fill out their application, Matney said.
How many Iowans have renewed their coverage?
As of June, 854,791 people were enrolled in Iowa Medicaid and CHIP. That’s 39,053 fewer than in April.https://flo.uri.sh/visualisation/14502335/embed
In the first three months of the “unwinding” process, 105,401 enrollees renewed their coverage under the Iowa Medicaid program, according to state data.
Of those, about half — 51,940 — were renewed on an “ex parte basis” or automatically renewed based on information the state has on the enrollee. The remaining 53,461 enrollees who renewed their coverage filled out and returned the redetermination paperwork sent by the state.
Federal officials call on states to do more. What is Iowa saying?
As the redetermination process continues for the next several months, Matney said she expects the number of individuals disenrolled, including for procedural reasons, will level off.
State officials had flagged enrollees who were likely ineligible for continued coverage, and frontloaded their reviews early in the redetermination process. As a result, Matney said, the rate of procedural dropoffs from April through July will be higher than the remaining months of the unwinding process.
Matney said enrollee data shows as much as 85% of individuals disenrolled from Medicaid have insurance elsewhere, such as an employer-sponsored plan. It also shows most of those who were disenrolled are adults.
The remaining portion is likely still eligible for Medicaid, which is why the state implemented a 90-day grace period to allow members to reapply for coverage, even if they missed the deadline, Matney said.
“If they get their paperwork in within that 90 days, we’ll backdate to the date that they last covered, so there’s no gap,” Matney said.
Members will most likely find out they no longer have Medicaid coverage when they pick up prescriptions. Matney said a possible solution could come in the form of partnerships with pharmacies, allowing those providers to complete presumptive eligibility determinations and help members get back on Medicaid quickly.
However, she said many states are finding pharmacies are not signing on to help with that work.
CMS has recently taken steps to address the number of Americans kicked off Medicaid coverage during this process, even pausing redetermination efforts in some states that have violated federal regulations, according to a press briefing from last week. Federal officials did not list the states involved.
Tsai said CMS officials are continuing to call on states, especially those with higher rates of procedural dropoffs, to utilize federal waivers offered by CMS for states’ redetermination efforts. These temporary policy changes are structured to help ease the process for members and ensure the nation’s uninsured rate doesn’t spike.
Among those waivers is extending postpartum coverage for Medicaid recipients to a year, a policy that has not been adopted in Iowa. Currently, the state provides members with 60 days of postpartum coverage.
“Under that, there definitely is more room for Iowa to be able to take up more of those,” Tsai said.
Matney said at this stage in the unwinding process, she doesn’t see any need to use additional policies offered by federal health officials to ease the process.
“We’ve gone through the list and really done the analysis of what we’re already doing versus what would be more administratively complicated,” Matney said. “The juice isn’t worth the squeeze in some such situations, and so right now, we’re still in the same spot. But we’ll be evaluating that, and if we feel additional waivers are important and necessary to help ease the process for ourselves and for Medicaid members and Iowans in general, we’ll certainly pursue that.”
Michaela Ramm covers health care for the Des Moines Register.