Before the COVID-19 pandemic, states conducted routine checks to review
Medicaid
beneficiaries’ eligibility. State agencies would alert people if they no longer qualified — which could happen for a variety of reasons, such as getting a new job, moving, or finding private coverage — and would reenroll those who continued to qualify for Medicaid coverage. But since March 2020, states have stopped their typical Medicaid redetermination procedures as part of the federal government’s approach to the public health emergency.
In exchange for additional funding, states agreed to continuously reenroll those on Medicaid. Unsurprisingly, enrollment has skyrocketed. From February 2020 to October 2022, Medicaid enrollment grew by
more than 20 million
people. Research conducted by the
Foundation for Government Accountability
at the time found that as high as 90% of those who enrolled during the pandemic were no longer eligible by January 2022. Taxpayers have spent billions on continually reenrolling these nonqualified people for several years running. And most of this money has gone to Medicaid-managed care insurance companies that have pocketed billions.
This, however, is about to change, and states should move quickly to repair their programs.
At the end of last year, Congress
passed legislation
ending the continuous enrollment provision. States are finally free to reinstate their Medicaid redetermination procedures and can begin to remove ineligible people as soon as April 1. This is good news, but it does come with some complicated steps for states that are not prepared.
CLICK HERE TO READ THE WASHINGTON EXAMINER’S EMPOWERING PATIENTS IN HEALTHCARE SERIES
As enrollment for Medicaid grew, funds were diverted away from services for low-income children and pregnant women, those with disabilities, and certain elderly people. This is why rapidly reviewing everyone’s eligibility is so important.
Reviewing the entirety of states’ Medicaid rolls, however, is no small undertaking. States such as Iowa that passively continued to monitor enrollees’ eligibility (but not act on that information) will likely be better equipped to reinstate Medicaid redeterminations with minimal mistakes. By contrast, other states that completely stopped monitoring enrollees’ eligibility will be much further behind, and managed care companies will benefit from the delays as they get paid monthly for each enrollee.
Clear communication from the state about the anticipated timeline of Medicaid redeterminations is a good first step. But states must also be clear about how they will prioritize the reviews of those most likely to be ineligible. Categories of beneficiaries that saw the largest growth during the
COVID-19 pandemic
should be reviewed first, and agency officials should be transparent about which data sources they are using to review potential job changes and relocations or whether a person has received coverage elsewhere or has died.
States should also be transparent with lawmakers about how they will administer the redetermination process. Are they working with any third-party groups that have a financial incentive to maintain ineligible enrollees? Do they have enough eligibility workers to conduct the reviews? Has the state prepared for appeals to their determinations? And how will the agency report on the progress of their redetermination process? States must give an answer to these questions in order to successfully and quickly verify that the only enrollees on Medicaid are people that still qualify.
Medicaid redeterminations are a necessary integrity measure that help maintain Medicaid as a program for the most vulnerable. Don’t believe the headlines that say otherwise. No eligibility standards have been changed. Rather, states are just ensuring people on Medicaid still qualify. Billions of
taxpayer
dollars have lined the pockets of insurers for years, while many of the Medicaid enrollees they covered neither qualified for the program nor used any of their services. This has to stop.
This Washington-made problem is now up to state-government officials to fix. They need to act quickly but do so with a thoughtful plan to ensure that only those who qualify remain on Medicaid.
CLICK HERE TO READ MORE FROM RESTORING AMERICA
Josh Archambault is a visiting healthcare fellow at the State Policy Network.
