Red Flag Warning: The First Round of Medicaid Redetermination Numbers Are In

Jun 22, 2023

Earlier this week, the Department of Public Health and Human Services posted data from the first month of the Medicaid redetermination process. For more information on this process, known as the “unwinding,” read our blog: Medicaid Unwinding Requires Communication and Transparency. 

This round of early data shows a staggeringly high number of cases being closed due to procedural reasons, not because they are no longer eligible for Medicaid. Let’s take a look a deeper look at the numbers, what they mean, and what Montana can be doing to minimize harm for individuals, families, and communities.

How many people lost coverage?

The question on everybody’s mind is just how many people are going to lose coverage during this process. Cases from the first month can be sorted into four basic categories: 1) people whose Medicaid eligibility is still being determined, 2) people whose Medicaid is renewed, 3) people whose Medicaid coverage was ended due to ineligibility, and 4) people whose coverage was ended due to procedural reasons.

The numbers are discouraging. In April, only 28.8 percent of Medicaid cases were renewed, and nearly half (49 percent) were closed. The remaining 22.2 percent are still being processed.

But most concerning is the reasons why cases were closed. In the first month, 11,187 individuals had their cases closed (72.3 percent of all terminations) due to a failure to return requested paperwork. Only 20 percent of cases that were closed were terminated because the individual was no longer eligible for Medicaid. 

What should the state do next? 

The state can take three steps to reduce the high number of procedural closures: 

1) Slow the pace of redeterminations. Montana is moving through the process faster than almost every other state, with a plan to have initiated all redeterminations within 10 months. Not only is this significantly faster than the 12 months time frame the federal government has provided, but DPHHS is significantly frontloading the caseload, with over three-quarters of redeterminations taking place within the first six months. 

Despite just now seeing data from April half of all redetermination cases will have been initiated as of July 1. With such high levels of case closures being reported, the state should consider greatly slowing the pace of redeterminations so more people do not lose coverage.

2) Increase communications – A recent study shows that two-thirds of Medicaid recipients nationwide are unsure if states are allowed to remove people from Medicaid, highlighting widespread confusion about how the process will work. Montana, however, has lacked communications with individuals and communities. For example, Maryland has created a statewide information campaign with press conferences from state officials. North Dakota has created media toolkits for tribal communities, providers, and other leader to reach more individuals. 

The federal government has called for an “all hands on deck” approach, advocating for help from community leaders, local governments, tribal leaders, healthcare providers, faith-based organizations, and the private sector. A coordinated effort to ensure all Montanans on Medicaid are aware of the process and understand how to navigate could significantly reduce the number of people unnecessarily losing coverage.  

3) Pursue new flexibilities provided by the federal government – the Center for Medicare and Medicaid Services (CMS) has provided new opportunities for states to improve their redetermination process. These flexibilities include provisions such as using Supplemental Nutrition Assistance Program (SNAP) data, or auto-renewing people with incomes below 100 percent of the federal poverty level. 

Montana is one of only two states that have not pursued any of the additional flexibilities provided by CMS. These flexibilities are meant to ease the burden on states facing operational issues and prevent coverage loss, meaning there is no reason for Montana not to pursue them. 

What we still don’t know

While this round of data is highly concerning, just as concerning is the information we still do not know. We do not know how children, rural areas, tribal communities, and people of color are being impacted – groups at high risk of losing Medicaid through procedural disenrollments rather than lack of eligibility. 

Montana should take this first round of data as a red flag warning, and act immediately to improve the unwinding process to prevent further coverage losses. Health care coverage for thousands of Montanans is at stake.

Montana Budget & Policy Center

Shaping policy for a stronger Montana.

MBPC is a nonprofit organization focused on providing credible and timely research and analysis on budget, tax, and economic issues that impact low- and moderate-income Montana families.