With states knee-deep in the process of evaluating Medicaid eligibility after a three-year pause – renewing some peoples' coverage and removing others from the rolls – the Biden administration is warning local officials about failing to comply with federal requirements. 

What You Need To Know

  • The Centers for Medicare and Medicaid Services made public letters it sent to all 50 states flagging the areas in which individual states were falling short in meeting federal requirements in renewing Medicaid coverage 
  • In all, 36 states were warned about failing to meet standards in at least one category, five states were flagged for falling short in all three: Alaska, Florida, Montana, New Mexico and Rhode Island

  • The end of a pandemic-era policy earlier this year, meant states had to restart annual eligibility checks for those on Medicaid for the first time in three years – a monthslong process the federal government estimated will result in about 15 million people leaving the program

The end of a pandemic-era policy earlier this year, meant states had to restart annual eligibility checks for those on Medicaid – the government-funded health insurance program for low-income Americans – a monthslong process the federal government estimated will result in about 15 million people leaving the program.

While many may have become ineligible since 2020, the concern from some advocates is that people who do still qualify will lose coverage because they didn’t receive a notice to complete an eligibility check or didn’t understand the process – which is considered a procedural reason. 

This month, the Centers for Medicare and Medicaid Services made public letters it sent to all 50 states with data on the renewal process for the month of May. In the letters, CMS focused on three categories: average call wait times, the percent of people who lost coverage because of procedural reasons and application processing times – flagging the areas in which individual states were falling short. 

In all, 36 states were warned about failing to meet standards in at least one category. Five states were flagged for falling short in all three: Alaska, Florida, Montana, New Mexico and Rhode Island. 

In Florida, for instance, the average wait time in May was 32 minutes with 38% of calls abandoned. Fourteen percent of Medicaid beneficiaries up for renewal in May were cut because of procedural reasons and 10% of applications were processed in more than 45 days – the number of days CMS cited in the letters as meeting federal requirements. 

Call center waiting times ranged from less than a minute in a handful of states such as New York and North Carolina to up to 48 minutes in Missouri. 

According to the letters, Texas had the largest percentage of beneficiaries cut due to procedural reasons in May, amounting to 52% of all people up for renewal that month. 

The figures presented in the letters were only from the month of May and therefore have likely changed since. Some states did not report data for the month yet. 

In an interview on the topic with Spectrum News last month, Health and Human Services Secretary Xavier Becerra emphasized the numbers at this point are still preliminary. He mentioned that states started the process at different times and are taking different approaches, which can impact the data this early.  

“Some states are moving fast, some states are taking a little longer, some states still have a lot of paper processing instead of computer processing so it's going to take them longer,” Becerra said of differences in state’s approaches, “some decided to approach those Medicaid recipients who they believe have now found work, because those are the folks who are likely to disenroll because they no longer qualify for Medicaid.”

An analysis of data from 44 states and Washington D.C. by KFF Health News found more than 4.5 million people have been disenrolled from Medicaid as of Aug. 11. 

The provision included in the coronavirus relief package passed by Congress in 2020 offered states more federal funding if they agreed not to cut recipients from Medicaid to ensure they kept their health coverage during the pandemic. 

As a result, the number of people on the program ballooned over the pandemic. But the end of the policy earlier this year meant states had to return to regular operations, including updating Medicaid rolls and terminating people who are no longer eligible.