Renee Hanania, right, kisses her son, Branden Petro, who has been diagnosed with a mitochondrial disease. The family was told that she was no longer eligible for Medicaid, which meant they would lose the services of licensed practical nurse Pamela Mason, left. (Jefferee Woo/Tampa Bay Times/TNS)
Federal Medicaid officials say several states may be improperly cutting people out of Medicaid, a program many people with disabilities rely on for everything from health care to home and community-based services.
The Centers for Medicare & Medicaid Services sent a letter to state Medicaid directors last week decrying practices they say could be leading to some people who should remain eligible losing their coverage.
“CMS has become aware of additional systems and operational issues affecting multiple states, which may result in improper disenrollment of eligible individuals,” the document read. letter from Daniel Tsai, director of the CMS Center for Medicaid and CHIP Services. “These actions violate federal renewal requirements and must be addressed immediately.”
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During the COVID-19 public health emergency, states were offered additional federal funding for Medicaid as long as they did not kick most people out of the program. But with the end of the public health emergency in May, states are now working to redeterminate whether each of their Medicaid recipients continues to qualify for the program for the first time in years.
As of the end of August, states have disenrolled more than 5.5 million Medicaid recipients, 74% of whom were due to procedural reasons such as failing to complete required paperwork on time, according to data from KFF, a nonprofit organization that conducts health policy research.
The concerns raised by CMS center on what are known as “ex parte” renewals, or situations in which state Medicaid programs use existing data to automatically renew coverage for certain beneficiaries. The agency said it believes eligibility systems in several states are buggy, so automatic renewals are done at the family level rather than at the individual level.
As a result, states may send out renewal forms targeted at entire households, although certain individuals within the household should qualify for automatic renewal. In some cases, states have proceeded to terminate coverage for such individuals if other members of their household have not responded appropriately.
“Any state that conditions the renewal of Medicaid eligibility for persons in the household on the return of a renewal form, when the eligibility of such persons has already been established based on information available through the ex parte process, does not meet longstanding federal Medicaid and CHIP Renewal Requirements,” the guidance states.
CMS did not specify the states where the problem was identified, but all states are asked to review their systems and respond to the agency by September 13.
States that do not comply should immediately suspend disenrollments for all those affected, reinstate coverage for those affected, implement mitigation strategies and fix their systems and processes to meet federal requirements, Tsai said. States that do not take the right course risk losing federal funds or being subject to a corrective action plan, the letter states.
CMS said the problem it identified is having a huge impact on children, who often have higher Medicaid eligibility limits than adults, but disability advocates said people with disabilities who live with their family are also at risk.
“Anecdotally, we hear that the redetermination process has been opaque, confusing and inconsistent for many beneficiaries,” said Zoe Gross, director of advocacy for the Autistic Self Advocacy Network. She cited cases in which people were told they would still be eligible for Medicaid and then kicked out. In other cases, she said, people only found out their coverage was revoked when they went to use their insurance and then had to spend days trying to figure out what happened.
“CMS’s letter to states is an important step, but CMS needs to do more,” Gross said. “CMS should name the states that are wrongly terminating people from Medicaid and push states to do much more than they are currently doing to make this process fair and navigable for recipients.”
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