Montana health officials ended Medicaid health insurance coverage for 19,244 people in May, bringing the total number of people removed from the public health program up to 34,204 since the state began reevaluating enrollee eligibility in April — an administrative power it did not have during the federally designated pandemic emergency.
The state health department, which is releasing updated figures on the redetermination process roughly once a month, published the summary of May data on Friday.
Nearly half of the 40,334 people up for consideration that month lost coverage, representing about 6% of the state’s overall Medicaid population. Twenty-eight percent of those people in the May group — 11,171 — had their coverage renewed, while the cases of another 9,919 enrollees were still being processed, a quarter of the month’s caseload.
Those percentages are similar to the department’s reported outcomes for the 31,596 individuals considered in April. Of that group, 47% lost coverage, a figure nearly identical to those in the May cohort.
In the first month of redeterminations, the department said 72% of people whose coverage ended had failed to return the required information. Another 20% had been deemed ineligible because of a change in income, household size or other qualifying factors.
The department did not provide a breakout of that information in its May summary. Asked for specific reasons for closure, health department spokesman Jon Ebelt said the agency would publish cumulative figures “not month by month, as the redetermination process can span multiple months depending on when requested information is returned.”
In its latest update, the department said 64% of the people who lost coverage had failed to provide required information, a 7% decrease from the figures for April alone. The cumulative number indicates that individuals are more than twice as likely to lose coverage for that reason — the next largest group shows about 25% of people lost coverage because of ineligibility.
Asked why the overall figure for information-related closures went down, Ebelt said the department is not conducting month-to-month comparisons.
“There are a number of reasons why individuals may choose to not return their redetermination packet or additional requested information, and DPHHS has no way of knowing what those reasons are in each case, so making comparisons month to month does not provide valuable insight,” Ebelt said.
Nationwide, more than 3 million people have been disenrolled from Medicaid since states began what the redetermination process commonly referred to as “Medicaid unwinding.” The rates of removal from Medicaid vary widely between states, all of which have unique policies and procedures when handling eligibility reviews.
Researchers at Kaiser Family Foundation, a national health policy nonprofit, found that an average of 74% of people who lost coverage did because of procedural reasons, such as incomplete or unreturned paperwork.
Tricia Brooks, a researcher at Georgetown University Center for Children and Families, said the trend has prompted some states to amend their process and extend the outreach period for people who did not complete the required steps.
“Everyone is surprised or disappointed about the large share of procedural disenrollments, hence several states pausing or taking advantage of rolling over [that group] an extra 30 days for targeted outreach. And by targeted outreach, I mean personalized and direct (not mass mailings or robot calls),” Brooks said in an email Monday.
Most states were not in compliance with federal requirements in the leadup to the unwinding process, Brooks added, a fact she said “illustrates how far we have to go for states to remove administrative hurdles and embrace technology” to help eligible people stay enrolled in Medicaid and improve state efficiencies.
Asked what the Montana health department had learned about redeterminations since the process began, Ebelt was nonspecific.
“DPHHS continues to move this process forward in a timely and efficient manner. We entered this process with a plan, and we continue to implement it. We encourage Montanans who have yet to update their contact information to do so to ensure they receive vital communications from DPHHS related to their health care coverage,” Ebelt said. He directed Medicaid enrollees who receive a redetermination packet to complete and return it, or go to apply.mt.gov to complete the verification process online.
Brooks and other health care experts have raised particular concerns about children who have been removed from Medicaid coverage and may experience a gap in care if their household does not immediately transition to another insurance option, such as an employer health care plan or coverage through the federal Health Insurance Marketplace.
Ebelt said nearly half of the individuals age 18 and younger reviewed in April — 6,922 out of 13,929 minors — lost Medicaid coverage. Though the department did not provide figures for lost coverage by age group in its May report, Ebelt said the cumulative number of minors who have lost coverage to date is now 13,748.
Whether minors or adults, Ebelt said the department “has no way of knowing” what insurance choices a person makes outside of Medicaid enrollment. He said individuals who have had their coverage discontinued have been referred to the federal marketplace for other options, and that anyone who has not returned the required information for Medicaid eligibility can do so at any time.
Montana health coverage advocates, including some of the state’s partners in the unwinding process, and state Democrats have criticized the Gianforte administration for the frequency of people losing coverage for procedural reasons.
At a July hearing of state lawmakers on the Children and Families Health and Human Services Interim Committee, Rep. Mary Caferro, D-Helena, forecasted that elderly residents and people with disabilities will have more difficulties reestablishing health coverage when they’re evaluated in the coming months.
“They’re some of the most vulnerable people, and they will experience some of the steepest climbs to get redetermined if the department doesn’t change what they’re doing now and get this right,” Caferro told the committee.
Evaluations for the 28,372 individuals in the June cohort are ongoing, according to the state. So far, about 21%, or 8,076 people, have had their coverage renewed. Roughly 33%, 12,873, have returned the required paperwork and are being reconsidered. Just under half of the month’s total group, 17,423 people, have not returned the requested information.
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