After a three-year pause in Medicaid disenrollments, the continual enrollment provision ended on March 31, 2023, kicking off a protracted course of during which states have been required to finish renewals verifying the eligibility of all enrollees in this system. States have been permitted to renew disenrollments in April 2023, however some states delayed the beginning of their unwinding durations till June or July 2023. By August 2024, all however three states have accomplished their unwinding durations (one further state, New York, has not set an finish date for unwinding). States additionally had appreciable flexibility in how they carried out their unwinding plans, and these choices possible affected renewal outcomes. For instance, 17 states opted to prioritize “possible ineligible” enrollees early of their unwinding interval, whereas some states selected to de-prioritize sure susceptible populations for later within the unwinding interval. States additionally carried out a considerable variety of coverage and procedural adjustments main as much as and in the course of the unwinding, comparable to adopting federal flexibilities, updating eligibility programs and processes, and experimenting with new outreach methods and partnerships.
Through the unwinding interval, states have been required to report month-to-month knowledge on renewal outcomes, offering for the primary time, a mechanism for monitoring the renewal course of throughout states. Up to now, roughly 24 million have been disenrolled and 54 million have had their protection renewed in the course of the unwinding. Consequently, nationwide Medicaid/CHIP enrollment has declined by greater than 13 million (13.9%) from its peak firstly of unwinding and stands at 82 million individuals enrolled as of April 2024. As a result of enrollment knowledge embody new individuals getting into this system in addition to individuals reenrolling after dropping Medicaid, the web change in enrollment is smaller than the entire disenrolled in the course of the unwinding. April 2024 enrollment remains to be roughly 10.4 million (14.6%) increased than pre-pandemic enrollment ranges of about 71 million, although most states had not but completed their unwinding durations as of April 2024.
This coverage watch makes use of unwinding knowledge collected by way of KFF’s Medicaid Enrollment and Unwinding Tracker to look at how national-level renewal outcomes modified over the course of unwinding, together with adjustments within the share of people that had their protection renewed or have been disenrolled from Medicaid every month. States’ unwinding durations have been aligned and are reported as months into the unwinding interval (e.g., Month 1, Month 2, Month 3…). For instance, Month 1 for Arizona is April 2023 however June 2023 for California. The information replicate up to date renewal studies, the place out there, which follow-up on outcomes for instances initially reported as pending. As a result of lag in reporting up to date knowledge, some states’ up to date renewal studies aren’t out there for later months.
Over the course of the unwinding interval, the share of individuals whose protection was renewed elevated whereas the share who have been disenrolled dropped. From the beginning of every state’s unwinding interval in Month 1 by way of Month 12, the share of people that retained Medicaid elevated from 58% to 66% (Determine 1). Over the identical interval, the share of disenrollments declined from 38% to 23%. A large drop within the variety of individuals disenrolled every month, from 2.8 million individuals within the first month to 1.6 million individuals within the twelfth month, seems to be driving the tendencies, though the variety of individuals whose protection was renewed every month elevated barely over the interval from 4.1 million to 4.6 million. The lower within the variety of individuals disenrolled partially displays states working by way of their “possible ineligible” populations within the early months of unwinding, in addition to states’ coverage and procedural adjustments in response to early unwinding knowledge.
Amongst those that retained protection, the share of individuals renewed on an ex parte foundation elevated from 51% in Month 1 to 70% in Month 12 (Determine 2). Ex parte renewals, also called auto-renewals, require states to confirm an enrollee’s eligibility based mostly on knowledge out there to the state with out requiring the enrollee to submit documentation. The Facilities for Medicare and Medicaid Companies (CMS) inspired states to extend ex parte renewal charges – and offered new flexibilities in the course of the unwinding interval for them to take action – as a method to assist eligible individuals keep away from dropping Medicaid protection in the course of the renewal course of. Notably, there was a big improve in ex parte renewals in Month 7, leaping from 57% to 68%. The timing of this soar in ex parte renewals displays many components, together with coverage and procedural adjustments, in addition to CMS taking enforcement motion in 29 states to handle noncompliance with federal ex parte necessities.
Though the entire variety of disenrollments declined in the course of the unwinding interval, amongst individuals disenrolled from Medicaid, the share of individuals disenrolled for procedural causes remained excessive. Procedural disenrollments happen when somebody’s eligibility (or ineligibility) couldn’t be verified, sometimes as a result of the renewal course of was not accomplished. Through the unwinding, procedural disenrollments as a share of whole disenrollments decreased from 74% in Month 1 to 66% in Month 12 (Determine 3). Nevertheless, whereas states took steps to cut back procedural disenrollments by way of elevated outreach to enrollees and different coverage and procedural adjustments, roughly two-thirds of people that have been disenrolled from Medicaid in Month 12 of unwinding misplaced protection for procedural or paperwork causes, reflecting ongoing points with the renewal course of.
The nationwide knowledge current a high-level image of renewal outcomes in the course of the unwinding however masks variations throughout states. For instance, whereas most states skilled positive factors in ex parte renewal charges in the course of the unwinding, the magnitude of the adjustments diverse. Equally, in most states, the procedural disenrollment fee declined, however in some states the speed elevated, presumably reflecting pauses in procedural disenrollments within the early months of unwinding or different procedural points. Variations in state insurance policies, procedures, enrollee populations, and system capabilities are possible the largest components driving the variation in renewal outcomes throughout states. Nevertheless, extra evaluation is required to grasp which components had the most important impression on renewal outcomes.
