Medicaid Unwinding Requires Communication and Transparency

Feb 22, 2023

In early 2020, Congress passed a law that gave states extra federal funds to keep people on their Medicaid rolls during a time of nationwide health and financial crises. This continual health coverage has meant that thousands of Montanans have not had to worry about losing their insurance in uncertain times.

As the pandemic’s influence over our lives shifts, Congress has permitted states to start removing people from Medicaid who no longer meet the eligibility requirements. This “unwinding” of Medicaid can start on April 1st. States have one year to begin redetermining the eligibility of everyone on the state’s Medicaid plan and must have finished the process by May 31, 2024. The additional federal dollars the state has been receiving during the pandemic will phase out through the year and end on December 31, 2023.

This process will be a significant undertaking – 3 out of every 10 Montanans (316,000) receive a form of Medicaid coverage, and they will all need to go through the redetermination process. Many Montanans will have moved or changed jobs during the pandemic, and their contact information may no longer be up to date with the Department of Public Health and Human Services (DPHHS). Montanans on Medicaid can and should update their contact information online to help ensure they receive important notices. 

DPHHHS has stated that it plans to take ten months to complete the renewal process. Centers for Medicare and Medicaid Services (CMS) has warned states against moving any faster than this, encouraging them to process no more than one-ninthof caseloads in a month. Processing a high number of redeterminations in a given month would also cause a high number of redeterminations to occur that month in future years, creating an unbalanced workload for eligibility workers at the state level.

Montana’s priorities during the unwinding process should be clear communication and accuracy. While many people who no longer qualify for Medicaid will be able to find affordable insurance on the marketplace, some will be disenrolled due to administrative errors. These administrative errors will most impact children and people of color. The U.S. Health and Human Services estimates that between 40 and 64 percent of people of color who will be disenrolled will in fact still be eligible for Medicaid. A staggering seven out of ten children losing Medicaid will likely still be eligible. The state must take rigorous steps to ensure good communication and high levels of accuracy, otherwise these households will be forced to reapply or go without health insurance.

The unwinding is happening when DPHHS is facing significant staffing shortages, and already struggling to keep up with processing new Medicaid applications. Currently, Montana Medicaid application processing times are lagging significantly behind the Centers for Medicare and Medicaid Services (CMS) required 45-day processing time. In the past few months, approximately 40 percent of Montana's Medicaid applications are taking longer than 30 days to process, and 20 percent are taking longer than 45 days. In the rest of the country, two-thirds of renewals are processed in a week.

Montana, like many states, is experiencing a significant staffing shortage, and DPHHS is particularly struggling. While DPPHS has stated it will work with an outside vendor to help with application processing, the process will be difficult even with sufficient staffing. On-going communication with Medicaid recipients is necessary to ensure that all information is up to date. To minimize error, it is vital that the state use multiple means of contact multiple times before deciding to disenroll a person. Multiple contact attempts are essential to reach people without broadband internet, limited cell phone access, or who live in rural communities.

CMS will require that states submit monthly data on the unwinding process. For transparency during the process, states should make this data publicly available and include demographic information. Publishing unwinding data will help communities see how they are being impacted and be able to advocate for changes to the process if necessary.

For more information about the unwinding in Montana and how it could impact you, your clients, constituents, or loved ones, please visit Montana Primary Care Association’s page on Montana Medicaid Unwinding Information.

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.