Consumer / Employer, Payers

New Analysis Shows 9 Key Metrics That Will Support Medicaid Coverage During Redeterminations

Between eight to 24 million people could lose Medicaid coverage during the redetermination process, which began April 1, according to Kaiser Family Foundation. To mitigate losses, several states have implemented policies like taking the full year to complete renewals and automating the process.

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With eight to 24 million people poised to lose Medicaid coverage during the redetermination process, the Kaiser Family Foundation (KFF) has identified nine metrics that states are following to mitigate losses.

Medicaid redetermination is the process states use to determine if enrollees are still eligible for Medicaid. During the public health emergency, states were banned from disenrolling people from Medicaid via the continuous enrollment provision, which ended March 31.

The nine metrics KFF found fall under three categories:

Renewal policies

  • The state is taking 12 to 14 months to complete Medicaid renewals
  • The state is following up on returned mail
  • The state is following up with enrollees who haven’t responded to a renewal request before ending their coverage

System capacity measures

  • The process for renewing enrollees is “mostly automated”
  • Fifty percent or more of renewals are done on an “ex parte basis,” meaning renewing coverage without the enrollee completing requirements
  • The state is working on improving ex parte renewal rates

Eligibility policies

  • The state has expanded Medicaid
  • The state extended postpartum coverage to 12 months
  • The state has 12-month continuous eligibility for children in Medicaid and CHIP

KFF’s analysis found that only Colorado has adopted all nine of these metrics, and another seven states have adopted at least eight (including Washington, New Mexico, Illinois, Indiana, Virginia, North Carolina and Massachusetts). Another seven states are only meeting four or fewer of these metrics (including South Carolina, Missouri, Arkansas, Oklahoma, Nebraska, South Dakota and Wyoming). 

However, Arkansas, Nebraska and North Dakota did not provide data on the share of ex parte renewals and Ohio and Texas are not included in the analysis. KFF also noted that the report shows data from January and that it’s possible that some states have changed their policies since then.

The report also discovered that 42 states don’t meet all three of the system capacity measures metrics.

“The administrative burden on both staff and enrollees is likely to be higher in these states and they will likely face unique challenges as they work to complete the increased volume of renewals during the unwinding period,” the report stated.

In addition, only 14 states have all three of the eligibility policies in place, KFF showed.

“While these policies are not directly related to the ability to complete the renewal process, they do affect how frequently an enrollee may have their eligibility redetermined, and in the case of adoption of the Medicaid expansion, the likelihood that nonelderly adults will be able to retain coverage when their eligibility is redetermined during the unwinding period,” the researchers stated.

KFF added that just having these policies isn’t the only thing that’s going to affect Medicaid coverage.

“While this analysis examines state policies, how states implement those policies will be just as important a factor in how the unwinding proceeds across states,” KFF said. “Implementation, in turn, will be affected by state staffing capacity, the effectiveness of state outreach to and communications with enrollees, and state engagement with key stakeholders, including MCOs, providers, and community organizations, to assist with enrollee outreach efforts.”

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