CMS urges states to stem Medicaid losses during redeterminations

States must take better care not to expel eligible Medicaid enrollees from the program during the redeterminations process, a senior Centers for Medicare and Medicaid Services official said Tuesday.

States resumed reviewing their Medicaid rolls last month to identify beneficiaries whose incomes are too high to qualify after suspending redeterminations during the COVID-19 pandemic. In the handful of states that have released data on their actions so far, however, about eight in 10 of those losing coverage have been disenrolled for administrative reasons, not because states determined they earn too much.

Those administrative reasons include enrollees not responding to outreach from state agencies seeking updated information to assess whether they remain qualified for Medicaid benefits, often because their contact information is incorrect or out of date.

“Our priority and commitment is to do everything within our power to help keep people covered for the coverage that they’re eligible for,” Center for Medicaid and Children’s Health Insurance Program Services Director Dan Tsai said at a news conference Tuesday. “We are deeply concerned when we see large termination numbers—in particular with non-response—because our concern is that they’re eligible kids and families, he said.

State Medicaid agencies must try harder to connect with enrollees before cutting off coverage, Tsai said. “If someone hasn’t responded at the 30-day mark, we would love states to do additional outreach to those individuals before termination.” he said. CMS will act quickly when it determines states are not complying with federal rules, he said.

The primary reason Medicaid enrollees are not responding is most are unaware that eligibility reviews have restarted, Tsai said. According to survey findings the Kaiser Family Foundation published last week, 65% of Medicaid beneficiaries do not know about redeterminations.

The Health and Human Services Department projects that 15 million people, or 16.5% of enrollees, will lose Medicaid coverage as redeterminations continue over the coming months.

States should look beyond minimum federal standards and take an “all-hands-on-deck” approach, Tsai said. States should not rush the process, should work with CMS to devise local solutions and should collaborate with health insurance companies that administer Medicaid benefits, he said.

“It’s a call to our partners at the state level to continue to innovate, but also to take up more and more of the options that we have offered above the federal minimums,” Tsai said. CMS has already approved 185 waivers to allow states to customize redeterminations strategies, such as enabling them to use data from programs such as food assistance to affirm Medicaid eligibility, he said.

CMS will publish Medicaid redeterminations data early this summer, Tsai said.