Medicaid redetermination refers to the rollback of certain expansions of Medicaid services. This involves changes to certain eligibility criteria for Medicaid recipients. During the COVID-19 pandemic, states were required to leave people on Medicaid rolls regardless of eligibility status. Medicaid has just begun redetermining eligibility after the pandemic, with Utah’s state Medicaid program and the Department of Workforce Services (DWS) working in tandem to determine eligibility. This process will last over the next year. During this time, Medicaid members are assigned a review month and their case will stay open until then. Medicaid recipients are encouraged to continue to use benefits as normal until they receive notice of their review.
While Medicaid redeterminations are intended to remove ineligible members from Medicaid rolls, the process is causing severe disruption for individuals who are eligible but face coverage losses mainly due to procedural reasons. Members risk losing coverage due to changed mailing addresses, not being sufficiently notified of potential coverage losses, inaccurately filling out paperwork, and other reasons. Utah Medicaid encourages members to update their mailing address and phone numbers, look for correspondence from DWS, and to complete their paperwork in a timely manner.
Just a few months into the redeterminations process, Utah Medicaid reports 16,418 Medicaid enrollees were terminated for procedural reasons, such as failure to respond. The July 2023 report indicates the total pending applications received between March 1, 2020 and the end of July 2023 is 3,815. The total of Modified Adjusted Gross Income (MAGI) and non-disability applications is 3,792, meaning 23 applicants were disability-related applications. Of the applications in the metric above, only two were completed as of the last day of the reporting period and 19 remain pending as of the last day of the reporting period. The total beneficiaries for renewal initiated is 22,611 and the total beneficiaries due for renewal in this period is 29,571. Of the beneficiaries above, 11,384 are renewed and retained in Medicaid or CHIP. Renewed on an ex parte basis (meaning renewals were made automatically based on preexisting applications) is 7,145 while renewals based on pre-populated renewal is 4,239, and 503 were determined ineligible for Medicaid or CHIP and transferred to the federal Marketplace (Obamacare).
This data indicates the challenges in ensuring that those who need care remain eligible for Medicaid. It also shows the enormity of the task of reviewing thousands of claims and the risk that people will fall through the cracks for procedural reasons. The large amount of people indicated by these metrics demonstrates how serious the unwinding is during this time.