What's going wrong with Medicaid redeterminations

Outdated eligibility systems and staff shortages are making the Medicaid redetermination process more difficult, state officials told KFF. 

In a report published Jan. 10, KFF interviewed state officials in Arizona, Indiana and Pennsylvania, along with other organizations in those states involved in the process, including managed care plans and advocacy groups. 

The report also includes data from a previous survey of state Medicaid directors and focus groups with Medicaid beneficiaries. 

As of Jan. 16, 15 million people have been disenrolled from Medicaid since April 2023, when states began determining Medicaid eligibility for the first time since 2020, according to KFF.  Of those disenrolled, 71% had their coverage terminated for procedural reasons, rather than being determined no longer eligible for the program on the basis of income. 

Here are five challenges plaguing the redetermination process, according to KFF: 

1. Too few, or too many, communication attempts: Some states reported attempts to contact Medicaid beneficiaries not going through, even after receiving their correct address. In Florida, some individuals who signed up for emails about their coverage never received notifications. On the flip side, some Indiana organizations reported beneficiaries were overwhelmed by the volume of calls they received about their coverage.
   
   
2. Confusing messages: Study participants told KFF Medicaid renewal and termination notices can be difficult to understand and are not clear on what actions beneficiaries need to take to return their coverage.
   
   
3. Outdated eligibility systems: Eleven states told KFF their systems for processing renewals were old or difficult to use. In Pennsylvania, staff cannot conduct ex parte renewals for people enrolled in Medicaid and another program, like SNAP, officials told KFF, leading the state to require manual ex parte renewals.
   
   
4. Staff shortages: Many states reported staffing shortages, and burnout and low morale among employees as challenges. Some officials KFF interviewed said new or inadequately trained staff may contribute to disenrollments of people still eligible for Medicaid. 
   
   
5. Difficulty getting assistance: Some study participants told KFF it is difficult for enrollees to reach call centers for assistance with renewing their Medicaid coverage. Wait times for call centers can be even longer for non-English enrollees. 

Read KFF's full report here.