The unwinding of pandemic enrollment protections in Medicaid helped speed up states’ growth of eligibility for key teams and adoption of coverage and system modifications to streamline renewal processes for enrollees, in line with findings from a brand new KFF survey of state Medicaid officers. These modifications imply that the return to “routine” operations when the unwinding interval ends is not going to be a return to pre-pandemic operations in lots of states.
The survey examined actions states have taken to reinforce techniques, processes, and communications, in addition to key state Medicaid eligibility, enrollment, and renewal insurance policies and procedures in place for youngsters and most non-elderly adults as of Might 2024.
States report modifications within the following key areas:
Protection for youngsters and pregnant people: A number of states are taking steps to develop protection for youngsters and pregnant people. In 2024, 5 states elevated eligibility ranges for youngsters and/or being pregnant protection and eight states prolonged protection to sure immigrant kids and/or pregnant people. Eighteen states have eligibility ranges above the median for each kids (255% FPL) and being pregnant (210% FPL). Constructing on the expertise of steady enrollment throughout the pandemic, 13 states are looking for to maintain kids repeatedly enrolled in Medicaid for greater than a 12 months.
Automated renewal processes: All states reported taking actions to extend automated renewal charges throughout the unwinding. By automated renewals, additionally known as “ex parte” renewals, Medicaid eligibility staff use dependable information to confirm enrollees’ eligibility at renewal. This strategy decreases paperwork for enrollees and states in addition to gaps in protection. Forty-two states adopted waiver flexibilities to extend automated renewal charges, resembling permitting automated renewals for folks with out revenue or utilizing eligibility for different income-based help applications to substantiate Medicaid eligibility.
Different modifications: Along with bettering automated processes, ten states say they simplified renewal types, and 7 states prolonged the time enrollees have to reply to renewal notices. States have additionally boosted direct outreach to enrollees by way of a number of modes, together with textual content, e mail, and automatic calls, and 37 states plan to keep up the improved outreach.
Regardless of these modifications, states encountered quite a few obstacles to simplifying renewals for enrollees throughout the unwinding interval, together with workforce points and issues with their eligibility techniques. Most states (41) reported frontline eligibility workers vacancies, and 32 of those states recognized the affect of the vacancies as important or reasonable.
A companion KFF Medicaid survey analyzing eligibility, enrollment, and renewal insurance policies for seniors and folks with disabilities discovered eligibility insurance policies for these populations range throughout states, however states made equally wide-ranging modifications to streamline renewal processes for these enrollees. Different key takeaways embrace:
Utility processes for seniors and folks with disabilities: Most states (38) now use the identical processes to find out revenue eligibility for all Medicaid enrollees, however the necessity to doc belongings might make purposes extra onerous for seniors and folks with disabilities. All states however California require many on this group to display that their belongings are beneath Medicaid eligibility limits, and asset eligibility processes are sometimes extra cumbersome than the method for revenue.
Renewal insurance policies for seniors and folks with disabilities: Renewal insurance policies for seniors and folks with disabilities more and more resemble these for different populations. All responding states solely renew eligibility yearly for seniors and folks with disabilities, and 47 states present enrollees with 30 days to return renewal data and a 90-day reconsideration interval following a procedural disenrollment.
The twenty second annual survey of state Medicaid and CHIP applications officers was carried out by KFF and the Georgetown College Middle for Youngsters and Households in March 2024. The KFF Survey of Medicaid Monetary Eligibility & Enrollment Insurance policies for Seniors & Individuals with Disabilities was additionally carried out in March 2024 by KFF and Watts Well being Coverage Consulting. Total, 49 states and the District of Columbia responded to each surveys, though response charges for particular questions different. (Florida was the one state that didn’t reply.)
