The Biden administration recently issued warnings to state health officials, highlighting their failure to comply with federal requirements when determining Medicaid coverage for millions of individuals affected by the pandemic. The Centers for Medicare and Medicaid Services (CMS) have expressed concerns regarding the rushed process adopted by many states, resulting in people losing coverage for administrative reasons, despite still being eligible.
Although the CMS has been reluctant to take formal action against states that violate federal rules, it publicly disclosed letters sent to all 50 states, outlining three major areas of concern. These areas include high rates of Medicaid recipients losing coverage due to paperwork issues, lengthy call center wait times and abandonment rates, as well as slow application processing.
Notably, the data presented in the letters is based on states’ reports from May, thus making it necessary to consider the changes in numbers and the fact that not all states reported their data. While the focus has primarily been on Republican-led states rushing through the process, the letters highlighted 36 states, including blue states, for at least one issue. Five states, specifically Alaska, Florida, Montana, New Mexico, and Rhode Island, were flagged for all three concerns.
For instance, Alaska reported a termination of 28 percent of renewals in May for procedural reasons, raising concerns about eligible individuals, especially children, losing coverage. The state’s call center wait time was an average of 16 minutes, with nearly a quarter of callers hanging up before the process was complete. Similarly, Florida witnessed a 14 percent termination rate for procedural reasons in May, with an average call center wait time of 32 minutes and a call abandonment rate of 38 percent.
The CMS emphasized that excessive call center wait times and abandonment rates may indicate a failure on the part of states to meet the requirements for providing a meaningful opportunity to complete Medicaid and CHIP applications or renewals over the phone.
According to data from the Kaiser Family Foundation (KFF) tracking 42 states and the District of Columbia, as of August 9, over 4.1 million Medicaid enrollees had lost coverage, with 75 percent of them disenrolled due to administrative reasons. The CMS raised concerns that a high rate of procedural terminations could indicate beneficiaries not receiving notices, being unable to understand them, or failing to submit their renewals through the required channels.
In conclusion, it is evident that the Biden administration has taken the initiative to address the shortcomings in Medicaid coverage determination across various states. The CMS’s focus on procedural issues, call center wait times, and application processing aims to ensure a seamless and efficient process for individuals in need of Medicaid.
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