Nine states halt Medicaid 'procedural' terminations; other states have plans to address flaws in the process

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The end of the pandemic meant the resumption of eligibility verification for Medicaid, which has proved a difficult transition for some, and many beneficiaries are losing coverage, mainly because they haven't responded to recertification efforts.

Under pressure from the Centers for Medicare and Medicaid Services, nine states have "agreed to pause procedural terminations as they address potential violations of Medicaid renewal requirements," reports Dorothy Mills-Gregg of Inside CMS. And 35 states have approved mitigation plans "that must address various issues, particularly with renewal forms and with confirming Medicaid eligibility ex parte, to comply with federal renewal requirements." The states are Delaware, Idaho, Iowa, Maine, Minnesota, Mississippi, New York, West Virginia and Wyoming.

"Nearly 20 states did not let their beneficiaries renew using all modalities -- phone, mail, in-person or online -- and eight states requested more information on their requests for renewal than is needed to determine eligibility," Mills-Greg writes. "To fix these potential violations. . . some states have agreed to provide simplified forms, add instructions explaining what information is required or pre-populate renewal forms. . . . Plans can also include extending call center hours, letting individuals or organizations help beneficiaries submit renewals."

Mills-Greg reports that 26 states "entered a mitigation plan in part because they were not conducting renewals ex parte, which is where a beneficiary's eligibility is confirmed administratively with third-party data, like participation in the Supplemental Nutrition Assistance Program. Experts say renewing coverage via ex parte reduces paperwork, potentially saving enrollees from losing Medicaid coverage because of a missing form or they didn't return a renewal request on time."

California, Colorado, Illinois, Indiana, Kansas, Kentucky, Louisiana, Maryland, Massachusetts, Montana, New Hampshire, New Mexico, North Dakota, Rhode Island and Tennessee had "no identified violations of federal renewal requirements," Mills-Greg reports.

A state's political identity does not determine compliance with federal Medicaid requirements or the need for a mitigation plan. Arielle Kane, Families USA director of Medicaid initiatives, told Mills-Gregg: "It's not a political problem; it's a problem with the enrollment systems; it's a problem with our infrastructure; it's a problem with, you know, how we track people -- all of these things -- then I think it almost maybe will de-stigmatize it a little bit and help us get to solutions."