Saturday, December 2

Nearly 500,000 in U.S. Will Regain Medicaid Coverage After State Errors

Nearly 500,000 people, many of them children, will keep Medicaid and Children’s Health Insurance Program coverage after state officials discovered major errors in their procedures for reviewing program eligibility, federal officials said on Thursday.

After a pandemic-era policy that guaranteed Medicaid coverage lapsed in April, states began checking to see whether tens of millions of Americans covered by the programs still qualified, removing them from the rolls if their incomes had surpassed program limits, among other reasons.

Many states conducted the checks with software that automatically verified whether people were still eligible, using government databases to verify income levels. But 30 states, federal officials confirmed on Thursday, had been vetting statuses incorrectly.

As a result, legions of children lost health coverage when their parents did not return the required forms to confirm the eligibility of everyone in a household. The Biden administration last month warned states about the problem, giving them two weeks to report whether they had improperly disenrolled people. The timing of the notice raised questions about why it took so long for federal health officials and their state counterparts to recognize a fundamental failing in the renewal process.

“This will help strengthen access to Medicaid not just during this very challenging renewal transition but also in the long term,” Chiquita Brooks-LaSure, the Medicare and Medicaid chief, said at a news conference on Thursday.

The unwinding of Medicaid enrollment has had catastrophic consequences for poor families and children across the country. More than seven million people have lost coverage through the program since the enrollment requirement ended in April, according to state data analyzed by KFF, a nonprofit health policy research group.

Nearly 1.4 million children have lost coverage in states that have shared enrollment figures broken down by age. Children have more generous eligibility limits for enrollment in Medicaid, and thus greater leeway to remain on the rolls.

Daniel Tsai, a senior Medicaid official, said at the Thursday briefing that children are likely to make up a “significant portion” of the nearly 500,000 Americans keeping their coverage.

States are still reviewing data on who improperly lost insurance, he said.

The Biden administration ordered states that had discovered the errors to halt what are known as procedural disenrollments, which occur when a recipient does not confirm eligibility with a state Medicaid agency, then loses coverage.

Mr. Tsai said that some states had fixed the problem rapidly and would soon be able to restart eligibility checks “as long as they continue to have that fix in place and when they can guarantee that no eligible people are disenrolled because of the issue.”

Other states, Mr. Tsai added, could take months to make the fixes and resume enrollment decisions. Some of those whose coverage will be restored could still lose it again.

In many of the 30 states identified on Thursday, fewer than 10,000 people were affected by the technical errors, according to a spreadsheet that federal officials shared with reporters. But in Pennsylvania and Nevada, more than 100,000 people in each state were affected.

Kristle Muessle, a spokeswoman at Nevada’s Department of Health and Human Services, said in a statement that roughly 114,000 people regained Medicaid coverage after state officials learned of the erroneous disenrollments.

“Procedural denials have been paused while Nevada works on computer system enhancements,” she said.

The state figures published on Thursday were estimates, meaning that many more children may have been affected by the improper eligibility checks than are currently known. Some states that admitted to conducting the checks incorrectly are still assessing how many people were impacted, suggesting the total could be well over 500,000.

“The scope of this problem is large,” Joan Alker, the executive director of the Georgetown University Center for Children and Families, said.

Still, she noted, the numbers cited by the Biden administration on Thursday left out children who may have unfairly lost coverage in other ways. “This is not the only problem we have,” Ms. Alker said.

In Texas, she noted, where officials have made only modest use of automatic renewals, many children were losing coverage because of faulty enrollment procedures that the state had yet to correct. Nearly 900,000 Texans have lost coverage in the process so far, according to KFF, roughly 80 percent of them children.

Sebastian Mixon, a father of three in Little Rock, Ark., said on Thursday that he and his children lost Medicaid coverage this summer for reasons that were still unclear to him.

A case worker at the shelter where he lives was helping verify their eligibility. But Mr. Mixon said he was feeling desperate. His daughter needed medications after a hospital stay, including a drug for depression. When he tried to retrieve them from Walgreens, he was told that she no longer had coverage, he said.

“It’s hard to do simple things like take them to urgent care, or if their tooth is aching and they need to see the dentist. It makes it impossible,” he said of losing Medicaid.

Christine Osterlund, the top Medicaid official in Kansas, one of the 30 states to identify the renewal errors, said in an interview that officials were reviewing eligibility decisions and reinstating coverage for children who might have erroneously lost it.

Other cases would receive careful individual review before they were disenrolled, she said. More than half of the roughly 81,000 people in Kansas who lost Medicaid as of Aug. 31 were children, according to KFF.

The technical problems with automatic renewals were just one glitch that the state faced, Ms. Osterlund said. Mail delays also caused some people to lose Medicaid until the state reinstated their coverage.

“When you’ve had three years of not having to worry about doing a renewal, our biggest issue was getting the reviews in timely,” she said, referring to how people could keep Medicaid during the pandemic without eligibility checks.

Kansas is one of just 10 states yet to take up Medicaid expansion under the Affordable Care Act, which would dramatically increase coverage for poor residents.

“There would be a lot more families in Kansas that would be able to have health insurance,” Ms. Osterlund said. The more people on Medicaid, she added, “the more healthy our work force is, the more healthy our children are.”

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