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Medicaid directors and caseworkers are faced with an enormous challenge as they unwind the pandemic continuous enrollment provision and verify income and eligibility for more than 93 million beneficiaries. Around 7.1 million individuals were scheduled for renewal at the beginning of the Pandemic Health Emergency Unwinding in July 2023, and 16.5 percent of those individuals scheduled for renewal were disenrolled due to procedural reasons.
A procedural disenrollment occurs when the state cannot verify an individual’s ongoing Medicaid eligibility at renewal. This lack of verification can lead to a loss of Medicaid coverage even if the individual is still eligible for the benefit. Additionally, many of those losing coverage when they really are still eligible due to procedural disenrollment lack another source of health insurance. For the state’s part, failure to identify or address issues of noncompliance can result in states having to submit corrective action plans or be subject to civil penalties.
Since the start of unwinding, there has been significant variations from state to state in the methods used to process renewals, according to KFF. This reflects differences in both timing as well as state approaches to the unwinding as they have adopted a number of different strategies to help reduce procedural disenrollments. On Sept. 21, the Centers for Medicare & Medicaid Services (CMS) announced 30 states would need to reinstate coverage for approximately 500,000 individuals who were mistakenly disenrolled due to an issue in processing ex parte renewals. A majority of those individuals who lost coverage were children who depend on coverage through Children’s Health Insurance Program (CHIP) services.
As caseworkers address the backlog of renewals, state Medicaid leaders should consider supplementing public information with third-party data sources such as The Work Number to help improve ex parte renewal processes and limit unnecessary procedural terminations.
While the public data sources caseworkers often rely on are often ‘stale’ or ‘out of date,’ The Work Number provides access to current information updated each time a participating employer or payroll provider processes payroll. This can help state Medicaid staff access current data instantaneously for use in their ex parte process to streamline and expedite Medicaid renewals.
Download the “Transforming Medicaid Eligibility Systems for Empathy at The Edge” paper to learn from industry leaders on how automation and commercial data sources, such as The Work Number, can be utilized to help build more user-friendly Medicaid eligibility systems and aid state Medicaid agencies throughout the unwinding of continuous enrollment.