Lawmakers Request More Info on Medicaid Redetermination Compliance

Lawmakers are calling on CMS and HHS to provide additional information on Medicaid redetermination standards following early reports of disenrollments due to administrative issues.

In a letter to HHS Secretary Xavier Becerra and CMS Administrator Chiquita Brooks-LaSure, Senate Finance Committee Chairman Ron Wyden (D-Ore) and House Energy and Commerce Committee Ranking Member Frank Pallone, Jr (D-NJ) raised concerns about recent Medicaid eligibility redeterminations.

Early evidence has indicated some states are not following redetermination standards, creating confusion and leading to coverage losses for beneficiaries.

“We are troubled by early reports that suggest that some states in the first month of redeterminations have disenrolled hundreds of thousands of individuals for procedural reasons, rather than because they were found to be no longer eligible,” the letter stated. “We are equally troubled that many of those individuals who have lost coverage are children, including newborns.”

Reps Wyden and Pallone cited one instance of a family of a five-year-old with cancer that spent hours on the phone with Florida’s Medicaid agency to determine if their son had lost coverage after the website said he had.

Florida has been moving through redeterminations quickly, with 250,000 individuals losing Medicaid coverage during the first month. More than 80 percent of beneficiaries lost coverage for procedural reasons and are likely children and parents.

Data showed that Arkansas is also processing redeterminations at a fast pace. Over 72,000 beneficiaries have lost coverage so far, 40 percent of whom are children and 72 percent of whom lost coverage for procedural reasons.

The Consolidated Appropriations Act of 2023 established requirements that states must follow to continue receiving enhanced funding.

States must maintain current eligibility standards through 2023, conduct Medicaid eligibility redeterminations following federal requirements, and ensure they have up-to-date contact information before redetermining a beneficiary’s eligibility. States must also demonstrate good-faith efforts to contact individuals more than one way before terminating their enrollment based on returned mail.

Reps Wyden and Pallone have urged CMS to take enforcement action that will prevent unwarranted coverage terminations. They also requested additional documentation to understand how states are complying with the Consolidated Appropriations Act requirements.

The letter asked for a list of the states identified as being out of compliance with Medicaid redetermination requirements, copies of the state risk mitigation plans approved by CMS, and an immediate release of the initial redetermination data states are required to submit.

The lawmakers also requested information on when CMS requires a state to implement a corrective action plan, the criteria CMS will use to determine when enforcement action is needed, and ongoing data for any state that requires a corrective action plan.

Days after Reps Wyden and Pallone sent their letter, Becerra penned a letter to the United States governors, offering strategies to reduce coverage losses during the redetermination process.

“I am deeply concerned with the number of people unnecessarily losing coverage, especially those who appear to have lost coverage for avoidable reasons that State Medicaid offices have the power to prevent or mitigate,” Becerra wrote.

“Given the high number of people losing coverage due to administrative processes, I urge you to review your state’s currently elected flexibilities and consider going further to take up existing and new policy options that we have offered to protect eligible individuals and families from procedural termination.”

The new flexibilities allow states to spread renewals over 12 months, allowing more time to run a smooth process and prevent systems from getting backlogged. States can also renew individuals’ coverage based on eligibility for other programs, including the Supplemental Nutrition Assistance Program (SNAP) or Temporary Assistance for Needy Families (TANF).

The new options allow managed care plans to help beneficiaries complete renewal forms, permit pharmacies and community-based organizations to help reinstate coverage for those who lost coverage due to procedural reasons, and let states delay administrative termination for one month while conducting additional outreach.