Kaiser: At least 612K Americans & counting have lost coverage via #MedicaidUnwinding for procedural reasons so far

A month ago I posted a post which included a very incomplete, rudimentary look at just how many Americans had lost Medicaid or CHIP coverage due to the ongoing Medicaid Unwinding process playing out nationally, based on initial data reported by Joan Alker, Executive Director of the Center for Children & Families at the Georgetown University Health Policy Institute:

...data is only available for 8 states so far; for another, the data from those states is a mish-mash, clearly broken out in some but only partial in others, and some only include percentages instead of hard numbers.

Even so, you can already see that at least 258,000 people have lost Medicaid coverage due to paperwork/clerical issues in just Arkansas and Florida alone...in just the first two months of the unwinding process.

Well, the Kaiser Family Foundation has taken up the mantle on this front, and the data so far, while still limited, is pretty much as bad as many healthcare advocates feared. via Hannah Recht as of June 1st:

More than 600,000 Americans have lost Medicaid coverage since pandemic protections ended on April 1. And a KFF Health News analysis of state data shows the vast majority were removed from state rolls for not completing paperwork.

Under normal circumstances, states review their Medicaid enrollment lists regularly to ensure every recipient qualifies for coverage. But because of a nationwide pause in those reviews during the pandemic, the health insurance program for low-income and disabled Americans kept people covered even if they no longer qualified.

Now, in what’s known as the Medicaid unwinding, states are combing through rolls and deciding who stays and who goes. People who are no longer eligible or don’t complete paperwork in time will be dropped.

The overwhelming majority of people who have lost coverage in most states were dropped because of technicalities, not because state officials determined they no longer meet Medicaid income limits. Four out of every five people dropped so far either never returned the paperwork or omitted required documents, according to a KFF Health News analysis of data from 11 states that provided details on recent cancellations. Now, lawmakers and advocates are expressing alarm over the volume of people losing coverage and, in some states, calling to pause the process.

That was two weeks ago. Since then, more data has been collected and the numbers have grown dramatically:

At least 1,078,000 Medicaid enrollees have been disenrolled as of June 13, 2023, based on the most current data from 21 states. Another 1.5 million enrollees had their coverage renewed, though four of the 21 reporting states do not provide data on renewed enrollees. At least 2.6 million total renewals were completed across the 21 states. However, these data undercount the actual number of disenrollments because not all states have publicly available data on total disenrollments.

The median disenrollment rate is 44%, but there is wide variation across states ranging from 12% in Nebraska to 73% in Idaho. For Idaho, the disenrollment rate is among only those enrollees whose coverage was maintained during the pandemic and who the state believes are no longer eligible, which may explain, in part, the higher disenrollment rate. Differences in who states are targeting with early renewals as well as differences in renewal policies and systems capacity likely explain some of the variation in disenrollment rates.

...There is also wide variation in rates of procedural disenrollments across states reporting this breakout, ranging from 89% in Kansas to 33% in Colorado. Procedural disenrollments are cases where people are disenrolled because they did not complete the renewal process and can occur when the state has outdated contact information or because the enrollee does not understand or otherwise does not complete renewal packets within a specific timeframe. High procedural disenrollment rates are concerning because many people who are disenrolled for these paperwork reasons may still be eligible for Medicaid coverage.

Here's a summary of the state data Kaiser has compiled so far. In short, nearly 1.1 million have lost coverage in these 21 states, of which at least 612K are for purely procedural/red tape reasons. That's more people than the entire population of Wyoming...and again, it's likely much higher than that. Even if you restrict it to these 21 states, if you assume that the ratio in the 7 states which haven't broken out their data yet is similar to the 14 which have (76% via procedural reasons), it suggests perhaps ~210K more across those, or roughly ~822,000 losing coverage for procedural reasons across all 21.

Taking this one step further: Total Medicaid/CHIP enrollment across these 21 states combined represents around 36.1% of total Medicaid/CHIP enrollment across all 50 states + DC. While both the disenrollment protocols/rates as well as the procedural disenrollment rates are likely all over the place in the other 20 states +DC, assuming similar proportions across the rest of the country, we're looking at something in the neighborhood of 3 million people having lost coverage so far total, of which perhaps ~2.2 million or so would be due purely to administrative red tape and other procedural reasons alone.

With that in mind, the Health & Human Services Dept. (HHS) has announced some additional flexibilities for states to utilize in an attempt to minimize these coverage losses...assuming the states actually want to do so, which is true in some cases and, let's just say, not so much in others. Via Dorothy Mills-Gregg of Inside Health Policy:

Managed care plans can help Medicaid beneficiaries complete their renewal forms if the state allows, HHS Secretary Xavier Becerra announced Monday (June 12) along with other new state redetermination flexibilities, while pressure increases for the administration to penalize states with mass disenrollments that the Kaiser Family Foundation estimates have reached about 1 million beneficiaries.

...“Given the high number of people losing coverage due to administrative processes, I urge you to review your state’s currently elected flexibilities and consider going further to take up existing and new policy options that we have offered to protect eligible individuals and families from procedural termination,” Becerra wrote.

The letter suggests states adopt new policies like using Supplemental Nutritional Assistance Program or Temporary Assistance for Needy Families to check eligibility, managed care plans or enrollment brokers to update beneficiary contact information, and extending automatic re-enrollment into Medicaid managed care plans up to 120 days.

HHS also recommends states partner with managed care plans, schools, community-based organizations, faith-based organizations, grocery stores and pharmacies to help beneficiaries understand the Medicaid and Children’s Health Insurance Program.