5 Takeaways on Unwinding of Continuous Medicaid Enrollment

December 05, 2023

We are past the six-month mark for the unwinding of the pandemic’s continuous enrollment provision for Medicaid enrollees.

With the end of the public health emergency, Pennsylvania and other states are now required to determine eligibility for beneficiaries to remain enrolled in the program.

The Kaiser Family Foundation (KFF), CMS, providers, and other health care organizations have been tracking the redetermination process throughout the year. Here are five key takeaways:

• By the numbers:  Nearly 11.8 million Medicaid enrollees have been disenrolled and 22.1 million have had coverage renewed since April, according to KFF’s Medicaid Enrollment and Unwinding Tracker.
  • In Pennsylvania, 318,000 have been disenrolled and more than 580,000 had coverage renewed.
• Reasons for disenrollment:  Across the U.S., 71 percent of people were disenrolled due to procedural reasons, meaning they did not complete the renewal process, KFF figures show. This can happen if states have outdated contact information or beneficiaries are not aware they need to update their application.
  • In Pennsylvania, 45 percent of people were disenrolled for procedural reasons, and 55 percent were determined ineligible.
• Signing up:  Nearly all (89%) reenrolled beneficiaries completed a renewal form in Pennsylvania, KFF noted. Just 11 percent had their renewal through an ex parte basis, meaning they were deemed eligible through verification from other available data sources.
• Noteworthy:  This week, CMS issued an interim final rule requiring states to submit corrective action plans if they are not following monthly reporting requirements and potentially face fines if they remain out of compliance.
• Quotable:  “The high rate of procedural disenrollments suggests that the options and strategies that CMS has been working with states to implement through their mitigation plans may not be sufficient to protect the continued enrollment of individuals who continue to meet substantive eligibility criteria,” CMS noted in its interim final rule.

With the end of continuous enrollment, the Department of Human Services (DHS)—in partnership with provider organizations, including HAP—has developed resources to help providers share important information with patients.

DHS’ stakeholder toolkit includes printable education materials, scripts for conversations with patients, and digital assets, such as social media posts and website graphics. The toolkit is available online.

The KFF’s Medicaid Enrollment and Unwinding tracker and the new CMS interim final rule are available online.