Nearly 500,000 people, many of them children, will keep coverage under Medicaid and the Children’s Health Insurance Program after state officials discovered major errors in their procedures for verifying program eligibility, federal officials said Thursday.
After a pandemic-era policy that guaranteed Medicaid coverage expired in April, states began checking whether tens of millions of Americans covered by the programs still qualified, removing them from the rolls if their incomes had exceeded program limits, among other things.
Many states conducted the checks using software that automatically checked whether people were still eligible, using government databases to verify income levels. But 30 states, federal officials confirmed on Thursday, had done the status checks incorrectly.
As a result, legions of children lost health coverage when their parents failed to return the required forms to confirm the eligibility of everyone in a household. The Biden administration warned states about the problem last month, giving them two weeks to report whether they had improperly disenrolled people. The timing of the notice raised questions about why it took so long for federal health officials and their state counterparts to recognise a fundamental flaw in the renewal process.
“This will help strengthen access to Medicaid not only during this very challenging renewal transition, but also in the long term,” said Chiquita Brooks-LaSure, the head of Medicare and Medicaid, at a press conference on Thursday.
The rollback of Medicaid enrollment has been disastrous for poor families and children across the country. More than seven million people have lost coverage through the program since the enrollment requirement ended in April, according to state data analysed by KFF, a nonprofit health policy research group.
Nearly 1.4 million children lost coverage in states that shared enrollment figures by age. Children have more generous eligibility limits for enrolling in Medicaid, giving them more leeway to stay on the rolls.
Daniel Tsai, a senior Medicaid official, said at Thursday’s briefing that children are likely to make up a “significant portion” of the nearly 500,000 Americans who will keep their coverage.
States are still reviewing data on who improperly lost coverage, he said.
The Biden administration ordered states that discovered the errors to stop so-called procedural disenrollments, which occur when a recipient fails to confirm eligibility with a state Medicaid agency and then loses coverage.
Mr Tsai said some states had fixed the problem quickly and would soon be able to resume eligibility checks “as long as they continue to have that fix in place and as long as they can guarantee that no eligible people are being disenrolled because of the problem”.
Other states, Mr Tsai added, could take months to make the fixes and resume enrolment decisions. Some of those whose coverage is restored could still lose it.
In many of the 30 states identified Thursday, fewer than 10,000 people were affected by the technical errors, according to a spreadsheet federal officials shared with reporters. But in Pennsylvania and Nevada, more than 100,000 people in each state were affected.
Kristle Muessle, a spokeswoman for the Nevada Department of Health and Human Services, said in a statement that about 114,000 people regained Medicaid coverage after state officials learned of the erroneous disenrollments.
“Procedural denials have been paused while Nevada works to improve the computer system,” she said.
The state figures released on Thursday were estimates, meaning that many more children may have been affected by the improper eligibility checks than are currently known. Some states that have admitted to conducting the checks incorrectly are still assessing how many people were affected, suggesting the total could be well over 500,000.
“The scope of this problem is large,” said Joan Alker, executive director of the Georgetown University Center for Children and Families.
Still, she noted, the numbers cited by the Biden administration on Thursday left out children who may have unfairly lost coverage in other ways. “That’s not the only problem we have,” Ms Alker said.
In Texas, she noted, where officials have made only modest use of automatic renewals, many children have lost coverage because of faulty enrollment procedures that the state has yet to correct. Nearly 900,000 Texans have lost coverage so far, about 80 percent of them children, according to KFF.
Sebastian Mixon, a father of three in Little Rock, Ark., said Thursday that he and his children lost Medicaid coverage this summer for reasons that are still unclear to him.
A caseworker at the shelter where he lives helped him verify his eligibility. But Mr Mixon said he felt desperate. His daughter needed medication after a hospital stay, including one for depression. When he tried to get them from Walgreens, he was told she no longer had coverage, he said.
“It’s hard to do simple things like take her to the emergency room or if her tooth hurts and she needs to go to the dentist. It makes it impossible,” he said of losing Medicaid.
Christine Osterlund, the top Medicaid official in Kansas, one of the 30 states that identified the renewal errors, said in an interview that officials were reviewing eligibility decisions and reinstating coverage for children who may have lost it in error.
Other cases would be carefully reviewed on an individual basis before being disenrolled, she said. More than half of the roughly 81,000 people in Kansas who lost Medicaid on 31 August were children, according to KFF.
The technical problems with automatic renewals were just one glitch the state faced, Ms Osterlund said. Mail delays also caused some people to lose Medicaid until the state reinstated their coverage.
“When you don’t have to worry about renewing for three years, our biggest problem was getting the checks in on time,” she said, referring to how people were able to keep Medicaid during the pandemic without eligibility checks.
Kansas is one of just 10 states that have yet to take up the Medicaid expansion under the Affordable Care Act, which would dramatically increase coverage for poor residents.
“There would be a lot more families in Kansas that would be able to have health insurance,” Ms Osterlund said. The more people on Medicaid, she added, “the healthier our workforce is, the healthier our children are”.
