Nearly All States Failing in Medicaid Redeterminations

By Consumers for Quality Care, on November 29, 2023

Nearly All States Failing in Medicaid Redeterminations

Nearly every state has been unsuccessful in handling Medicaid redeterminations, according to the National Association for the Advancement of Colored People (NAACP) and other civil rights organizations and reported by Fierce Healthcare.

During the COVID-19 pandemic, federal policy prevented states from removing consumers from the Medicaid system, even if they no longer met the eligibility requirements. In April, however, when the public health emergency ended, so did this policy. Soon thereafter, many states began an “unwinding” process, determining anew whether Medicaid enrollees were still eligible for the program.

Although some consumers have lost coverage because they no longer meet income eligibility requirements, many states have either engaged in procedural disenrollment or have failed to expand Medicaid coverage, leaving some consumers without any health care coverage.

The coalition graded each state’s policies regarding the Medicaid unwinding process. Their findings showed Hawaii to be the only state with a passing grade. On the other hand, the District of Columbia and half of states received incomplete grades, and the remaining half received failing grades. States that received failing grades had a procedural disenrollment of greater than five percent and had either not paused procedural disenrollment or expanded Medicaid.

According to NAACP President and CEO Derrick Johnson, this “report card shines the spotlight on the states who have not done the due diligence to ensure that every individual who’s qualified to be on Medicaid actually has access to it.”

According to Juliet Choi, President and CEO of the Asian & Pacific Islander American Health Forum, “Medicaid unwinding is one of the biggest health issues our nation has had to reckon with this year.” People of color have accounted for more than half of all consumers that have lost Medicaid coverage. Of those disenrolled from Medicaid, 70 percent still had eligibility but lost coverage due to procedural reasons. Among those losing coverage are children, many of whom have no access to any other health care coverage.

Gaps in medical coverage can have negative effects on a consumer’s health and finances. To better serve consumers, the coalition has called on states to pause the disenrollment process, re-enroll those eligible for Medicaid, and establish an automated renewal system.

CQC urges lawmakers and regulators to ensure that consumers do not face any lapses in health care coverage due to Medicaid redeterminations.