CMS halts Medicaid redeterminations in 'half-dozen states'

CMS has required around a half-dozen states to pause procedural terminations to correct errors through the Medicaid redetermination process, CMS officials told reporters on a July 19 press call. 

"Make no mistake, where we have found problems or violations of federal requirements, we are taking action to ensure that states correct the issue immediately," CMS Administrator Chiquita Brooks-LaSure said. "We are using every lever at our disposal to protect and preserve people's access to healthcare, and to work with states to address compliance issues that may hinder continued enrollment of eligible people." 

Ms. Brooks-LaSure said the agency would not name the specific states it had required to pause procedural disenrollments. 

Daniel Tsai, CMS deputy administrator and director of the Center for Medicaid and CHIP services, said the agency has required a half-dozen states to pause terminations and reinstate individuals whose Medicaid coverage was terminated without the full due process required. 

"As we've done in every situation to date with states, where we've identified an issue and directed states to pause procedural terminations and reinstate people and make remedies, our states have responded to that, they have complied, and we have collaboratively identified ways to make fixes while holding enrollees harmless," Mr. Tsai said. 

One of the most common issues the agency has identified is enrollees not being matched with the correct data to automatically re-enroll them in Medicaid, Mr. Tsai said. 

"Due to a range of system glitches, among certain populations, the electronic data matching fails. Those individuals did not receive what they're entitled to, which is the best chance of being able to match against data sources, and therefore you don't have people chasing the mail," Mr. Tsai said. 

As of July 19, at least 3 million people have been disenrolled from Medicaid since redeterminations began in April, according to KFF. Of those disenrolled, 74 percent were due to procedural reasons, rather than being determined ineligible for the program. 

The rates of procedural terminations vary by state, with three states — New Mexico, Georgia and South Carolina — and the District of Columbia reporting procedural termination rates above 90 percent. 

In June, CMS implemented additional flexibilities for states to keep more people covered, including allowing managed care plans to complete certain parts of renewal forms on beneficiaries' behalf and permitting states to delay Medicaid terminations for one month to conduct more targeted outreach. 

Mr. Tsai said if every state takes up the agency's additional flexibilities, procedural disenrollments will decrease. 

"That really is the bottom line, and is why we have been urging and partnering with states to do everything in their power to take on these additional policy flexibilities," he said. 

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