Our model using Treasury Department outlays is proving to be reasonably accurate in predicting Medicaid enrollment or, more relevant to the near term, disenrollment. In the last few weeks the think tanks, NGOs and other other policy types have offered the dimensionless numbers like "over 1M disenrolled for procedural reasons!" In turn pressure has been applied to the Biden administration, forcing SecHHS Becerra to push an "all hands on deck" approach to a grassroots information campaign.
(Note: disenrollment for procedural reasons means the beneficiary's eligibility could not be confirmed via an ex parte process that reviews available data like SNAP eligibility. In which case efforts to confirm income and other criteria have failed. The reasons people do not complete or return even pre-populated forms are varied but the most compelling factor is likely the availability of other insurance coverage.)
Disenrollment of 1M people is, of course, a tiny fraction of total enrollment and about 5% of the enrollment increase during the Public Health Emergency. The fact is that eligibility reviews are slow going. For example, it appears that in April California rolled its eligibility redeterminations into May. In Florida, 606k were scheduled for redeterminations. Of that amount, the redetermination process was initiated on 410K or about 67%. Of the 410K initiated redeterminations, 211k or 51% were determined eligible for Medicaid; 44k or 10% of were determined ineligible and 205K or about 50% were terminated for procedural reasons (i.e. a failure to respond).
In Indiana, which unlike Florida is an expansion state, 157k renewals were initiated. Of that amount 65k or 41% were determined eligible; 6k or 4% were determined ineligible and 30% determined ineligible for procedural reasons. Ohio, another expansion state, retained 69% of its beneficiaries after an enrollment check. About 6% were determined ineligible and 14% were disenrolled for procedural reasons.
Expect disparities like those to persist and more but the picture that should emerge is that state which are losing populations and experiencing higher than the national average will retain a higher number of those enrolled during the PHE. Also, expect the process to pick up speed as word gets around, especially if the SecHHS is successful with the "all hands" campaign.
Let me know if you have any questions.
Emily Evans
Managing Director – Health Policy
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