11 months ago

At the beginning of 2024, nine months into states’ efforts to unwind the Medicaid continuous enrollment provision and reverify enrollees’ eligibility, states have completed renewals for less than half of all enrollees.

To gain a better understanding of what challenges states are facing and the effects of different unwinding strategies, KFF interviewed state Medicaid officials in Arizona, Indiana, and Pennsylvania, as well as others involved, including representatives from Medicaid, managed care plans, legal aid organizations, and Marketplace navigators in Arizona, Florida, Indiana, and Pennsylvania. A new report highlights some key insights stemming from those interviews. For example:

• The volume of renewals, systems issues, and staffing shortages have posed significant challenges to states and, in turn, enrollees. In response, states have taken steps to streamline renewal processes and increase automated renewals. As of December, all study states except Florida had adopted waivers to increase automated renewal rates, and state officials noted that flexibilities related to verifying income and assets were most helpful at increasing those rates.
• States have also used an array of outreach strategies and partnered with multiple entities involved in the unwinding to reach Medicaid enrollees. All four states have increased communications with enrollees using emails, texts, and phone calls in addition to mailed notices. However, participants in the states said Medicaid renewal and termination notices can be difficult to understand, and long call center wait times hinder the ability of enrollees to get needed help.
• Some individuals who are disenrolled from Medicaid for procedural reasons are re-enrolling after a gap in coverage. While data on the share of people reenrolling are limited, study states are conducting additional outreach to enrollees who have been procedurally disenrolled to encourage them to complete the renewal process so they can reenroll if still eligible. Interview participants reported that, even with enhanced Affordable Care Act Marketplace premium subsidies, affordability remains a barrier to enrollment for people trying to transition from Medicaid to Marketplace coverage. The number of people disenrolled from Medicaid who enroll in Marketplace coverage remains modest in all four states, according to the people interviewed.

Nationally, the latest KFF tracking shows nearly 14.4 million people have been disenrolled and nearly 27 million reenrolled in Medicaid coverage. While many who are disenrolled may churn back onto Medicaid or transition to other coverage, many will likely become uninsured.

The report, Unwinding of Medicaid Continuous Enrollment: Key Themes from the Field, is available here.