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Federal authorities are emphasizing the urgent need for states to take proactive measures to avoid significant coverage losses as the backlog of Medicaid eligibility determinations continues in various regions. The Centers for Medicare & Medicaid Services (CMS) is actively encouraging states not only to meet but to surpass federal requirements in order to reduce the number of individuals losing their vital healthcare coverage and pursue Medicaid renewal.
Dan Tsai, CMS deputy administrator, emphasized the agency’s goal to reduce procedural terminations and maintain coverage for eligible individuals. CMS introduced policies to empower states in achieving this objective, expecting all states to adopt these flexibilities to decrease terminations and increase healthcare coverage. Full compliance with federal requirements and policy utilization will enhance healthcare access for residents.
COVID-19 Pandemic Impact: Temporary Suspension of Medicaid Renewals
Under normal circumstances, individuals enrolled in Medicaid or the Children’s Health Insurance Program (CHIP) undergo annual renewal processes. However, due to the COVID-19 public health emergency, these renewals were temporarily suspended. In a bid to support states during the pandemic, Congress raised the federal matching rate for state Medicaid payments under the condition that no individual would be removed from Medicaid rolls. As a result, eligibility redeterminations commenced on April 1, following disenrollments that occurred in February 2020.
Holding States Accountable: Ensuring Medicaid Coverage Continuity
To hold states accountable for their Medicaid enrollment procedures, Congress mandated states to submit monthly data to CMS, granting CMS the authority to enforce corrective action plans and impose fines when necessary. This measure aims to ensure states are committed to maintaining coverage for eligible individuals and prevent unnecessary coverage losses.
CMS Administrator Chiquita Brooks-LaSure has emphasized the paramount importance of keeping people connected to healthcare coverage. Before the pandemic, procedural reasons caused millions of people to lose their Medicaid and CHIP coverage annually, leading to delays and complications when attempting to regain coverage later on. With Medicaid and CHIP enrollment surging to nearly 95 million individuals, Brooks-LaSure acknowledges the unique challenges states face and highlights the Biden administration’s efforts to provide affordable health plans through the ACA marketplace.
As of July 19, data from the Kaiser Family Foundation (KFF) indicates that approximately 3 million Medicaid members had been disenrolled across 33 states and the District of Columbia. The primary reasons for coverage terminations were procedural issues such as outdated contact information or incomplete renewal packets. Many of the affected individuals could still be eligible for Medicaid or similar coverage, making it crucial to address bureaucratic barriers hindering their access to healthcare.
While CMS recognizes that the majority of states are compliant with the requirements, there have been instances of non-compliance in certain regions. To address this, CMS possesses the authority to require states to pause terminations, reinstate coverage, and adopt strategies to rectify noncompliance. States that fail to meet federal requirements are at risk of losing their enhanced federal funding.
To support states in ensuring compliance, CMS will provide technical assistance through new waivers and state plan amendments, which will help individuals maintain coverage or transition to suitable healthcare plans. Encouraging collaboration between managed care plans and providers will also enhance the efficiency of Medicaid enrollment and maintenance.
Though CMS has not publicly disclosed the states currently facing compliance issues, they have indicated that such information may be made available in the future if necessary. CMS plans to release data on Medicaid renewals in the coming weeks, providing a state-by-state breakdown to promote transparency and accountability.