How Did Medicaid Renewal Outcomes Change Through the Unwinding?

After a three-year pause in Medicaid disenrollments, the continual enrollment provision ended on March 31, 2023, kicking off a protracted course of through which states had been required to finish renewals verifying the eligibility of all enrollees in this system. States had 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 applied their unwinding plans, and these selections seemingly affected renewal outcomes. For instance, 17 states opted to prioritize “seemingly 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 applied a considerable variety of coverage and procedural modifications main as much as and throughout the unwinding, comparable to adopting federal flexibilities, updating eligibility techniques and processes, and experimenting with new outreach methods and partnerships.

Through the unwinding interval, states had 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. Thus far, roughly 24 million have been disenrolled and 54 million have had their protection renewed throughout the unwinding. Consequently, nationwide Medicaid/CHIP enrollment has declined by greater than 13 million (13.9%) from its peak at first of unwinding and stands at 82 million folks enrolled as of April 2024. As a result of enrollment knowledge embody new folks coming into this system in addition to folks reenrolling after dropping Medicaid, the online change in enrollment is smaller than the overall disenrolled throughout the unwinding. April 2024 enrollment continues to be roughly 10.4 million (14.6%) larger 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 means of KFF’s Medicaid Enrollment and Unwinding Tracker to look at how national-level renewal outcomes modified over the course of unwinding, together with modifications within the share of people that had their protection renewed or had 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 info mirror up to date renewal experiences, the place out there, which follow-up on outcomes for instances initially reported as pending. Because of the lag in reporting up to date knowledge, some states’ up to date renewal experiences 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 had been disenrolled dropped. From the beginning of every state’s unwinding interval in Month 1 by means 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 folks disenrolled every month, from 2.8 million folks within the first month to 1.6 million folks within the twelfth month, seems to be driving the traits, though the variety of folks 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 folks disenrolled partially displays states working by means of their “seemingly ineligible” populations within the early months of unwinding, in addition to states’ coverage and procedural modifications 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, often known as auto-renewals, require states to confirm an enrollee’s eligibility primarily based 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 supplied new flexibilities throughout the unwinding interval for them to take action – as a method to assist eligible folks keep away from dropping Medicaid protection throughout the renewal course of. Notably, there was a big enhance in ex parte renewals in Month 7, leaping from 57% to 68%. The timing of this bounce in ex parte renewals displays many elements, together with coverage and procedural modifications, in addition to CMS taking enforcement motion in 29 states to deal with noncompliance with federal ex parte necessities.

Though the overall variety of disenrollments declined throughout the unwinding interval, amongst folks 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 complete disenrollments decreased from 74% in Month 1 to 66% in Month 12 (Determine 3). Nonetheless, whereas states took steps to scale back procedural disenrollments by means of elevated outreach to enrollees and different coverage and procedural modifications, roughly two-thirds of people that had 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 throughout the unwinding however masks variations throughout states. For instance, whereas most states skilled positive factors in ex parte renewal charges throughout the unwinding, the magnitude of the modifications assorted. Equally, in most states, the procedural disenrollment price 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 seemingly the most important elements driving the variation in renewal outcomes throughout states. Nonetheless, extra evaluation is required to grasp which elements had the biggest influence on renewal outcomes.