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Preventing Fraud

Why have millions lost Medicaid coverage?

· 5 minute read

· 5 minute read


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  What can agencies do?


The stresses of the state agencies overseeing and managing the federal Medicaid program have always been intense. In 2023, their work has become even more challenging as millions of Americans lose the Medicaid coverage they’d received during the pandemic period’s Public Health Emergency (PHE).

The PHE’s continuous enrollment provision, which had halted Medicaid disenrollments since March 2020, ended on March 31, 2023. More than 94 million people had been enrolled in Medicaid and CHIP just before the provision’s unwinding. That means that there were more than 22 million people enrolled in Medicaid during the pandemic than were recipients in February 2020, the month before the Covid-19 PHE was declared.

Since the PHE Medicaid expiration date, states have been feverishly determining which Medicaid enrollees can still receive benefits, disenrolling those who appear to be no longer eligible for coverage. The numbers are daunting. Based on the data collected by California-based health policy research organization KFF, at least 8.8 million Medicaid recipients had been disenrolled as of October 16, 2023. Because states report their data at different times, KFF believes that its data probably undercounts the actual number of disenrollments.

Disenrollment is necessary not only because state agencies need to follow federal guidelines. These agencies also need to protect the funds they oversee. That requires agency employees to vigilantly identify anyone seeking to obtain coverage fraudulently. But there’s evidence that that many of those who are disenrolled might actually still be eligible. So how can agency staffers get the benefits to those who need them?

Why Medicaid is being lost

Why aren’t those still eligible receiving Medicaid benefits? The biggest reason why millions have lost Medicaid coverage that they’re entitled to is procedural. KFF data shows that 72% of those who’ve lost coverage since the PHE Medicaid expiration date were terminated for procedural reasons. These are typically folks who’ve changed addresses and thus didn’t receive renewal information. But even those who have received renewal packets don’t always have a clear idea of what these forms are for or how they need to be filled out. In some states, these problems are massive. As of mid-June, 89% of disenrollments in Indiana and West Virginia were due to procedural problems. And that’s just two states.

And with all the work they have had piled up on agency staffers’ desks, even eligible recipients who’ve turned in all the needed paperwork haven’t necessarily received benefits to which they’re entitled. According to KFF data, 35% of people with a completed renewal were disenrolled in reporting states as of mid-October.

This is a frustrating situation for both those eligible and for agency officials who want to fulfill their mission. What’s even more worrying for both agencies and recipients: In the 19 states that identify disenrollees by age, nearly 40% of those who lost Medicaid coverage as of October 16 were children.

What can agencies do?

In an effort to make it easier for both Medicaid applicants and the state agencies managing benefits, the U.S. Department of Health and Human Services (HHS) announced in June “new flexibilities” that states can use to keep people covered during the Medicaid and Children’s Health Insurance Program (CHIP) re-enrollment process. In a letter to state governors accompanying the announcement, HHS Secretary Xavier Becerra expressed particular concern about children’s loss of coverage.

HHS is offering several ways that state agencies can exercise flexibility for both enrollments and re-enrollments. The federal government is allowing states to delay an administrative termination for one month while they conduct outreach. This gives state agencies extra time to send out reminders to people to fill out and return their renewal forms. HHS also suggests that states partner with third parties such as managed care plans, pharmacies, schools, and community-based organizations to help individuals and families with Medicaid or CHIP renewals.

This has been good news for the millions who’ve lost Medicaid coverage this year. For agencies that want to help those who are truly in need (which all do), these “flexibilities” can allow them new ways to accomplish that mission. Still, this requires states to track down potentially eligible individuals and families. And that’s just part of state Medicaid agencies’ mission. They also need to protect the funds they oversee from fraud.

With all the data they have to verify, agencies need help from solutions that can provide updated contact information and verify addresses of people eligible to re-enroll–while getting ahead of fraudsters.

Fortunately, there are solutions available that can provide these capabilities. These days, agencies need all the help they can get. And in a sense, those who need Medicaid coverage also require that help.

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