Close to half a million people will regain their Medicaid and Children’s Health Insurance Program (CHIP) coverage after an issue with the redetermination process was discovered, the Centers for Medicare & Medicaid Services (CMS) announced on September 21.
During the pandemic, CMS paused Medicaid’s annual redetermination process, which checks recipient eligibility, to ensure no one lost government health insurance. The pause, which began in March 2020, was lifted in April 2023. Now, states are working through a three-year backlog—and it’s proving to be quite the challenge.
What’s the issue? Many states use software to automatically verify whether recipients are still eligible for Medicaid and CHIP, according to the New York Times. CHIP provides health coverage for children in families that earn too much money to qualify for Medicaid but not enough for private insurance.
CMS discovered that, so far, 30 states had an issue with the software that “inappropriately” disenrolled people from Medicaid and CHIP, “even when the state had information indicating that they remained eligible,” the agency said.
Because of the issue, around 500,000 recipients—many of whom are children, according to Daniel Tsai, deputy administrator and director for Medicaid and CHIP—lost their health insurance. Experts believe that figure is likely an undercount, as states are still reviewing data to see how many people lost coverage, the New York Times reported.
“The scope of this problem is large,” Joan Alker, a research professor and executive director and co-founder of the Center for Children and Families at Georgetown University, told the Times.
What now? CMS, a division of the US Department of Health and Human Services (HHS), will allow anyone who lost their insurance due to the error regain coverage while the states fix the problem.
“Thanks to swift action by HHS, nearly half a million individuals, including children, will have their coverage reinstated, and many more will be protected going forward,” HHS Secretary Xavier Becerra said in a statement. “We will continue to work with states for as long as needed to help prevent anyone eligible for Medicaid or CHIP coverage from being disenrolled.”
Navigate the healthcare industry
Healthcare Brew covers pharmaceutical developments, health startups, the latest tech, and how it impacts hospitals and providers to keep administrators and providers informed.
It could take months for some states to fix the issue and resume the redetermination process, Tsai told the Times.
The bigger picture. This isn’t the only issue that has caused improper Medicaid and CHIP disenrollments since redeterminations began in April.
Tsai told Becker’s Payer Issues in July that one of the most frequent problems CMS has seen since redeterminations began is people not being matched with the right data to automatically re-enroll them.
CMS paused redeterminations in a dozen states since April because too many recipients were disenrolled from Medicaid due to administrative errors instead of ineligibility, which is known as procedural disenrollment, Healthcare Dive reported. Nearly three-quarters of those who lost Medicaid coverage were kicked off because of procedural disenrollments.
“We are concerned, in particular, the majority of people that have lost coverage have lost coverage for what we call procedural reasons,” Tsai said during a media briefing in July, Healthcare Dive reported.
So far, at least 7.4 million people have lost Medicaid coverage as of September 22, according to KFF estimates. Up to 17 million people may lose Medicaid coverage during the redetermination period, Healthcare Brew previously reported.
With so many people losing Medicaid coverage, federally qualified health centers (FQHCs), which care for about one in six Medicaid recipients, are stepping up to fill in care gaps.
For instance, the Texas Association of Community Health Centers (TACHC), which represents 73 FQHCs, has encouraged its health centers to assist patients in either renewing their Medicaid coverage or enrolling in available federal health insurance plans.
“It’s all hands on deck. We all want to help our families—none of us want to see our families lose coverage,” Sonia Lara, TACHC’s outreach and enrollment director, told Healthcare Brew earlier this month.