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OARacle Newsletter

In late September, the Department of Health and Human Services (HHS) announced that nearly 500,000 people, mostly children, who had lost Medicaid and Children’s Health Insurance Program (CHIP) coverage due to procedural errors would be reinstated, according to The New York Times.

On September 29, HHS released a letter sent to state health officials emphasizing that states must provide 12 months of continuous coverage for children under the age of 19 on Medicaid and CHIP beginning January 1, 2024. In that same letter, officials also explained that states can request authority to extend the continuous coverage period for children beyond 12 months and adopt continuous coverage for adults eligible for Medicaid. As Chiquita Brooks-LaSure, administrator for The Centers for Medicare and Medicaid Services (CMS), noted in the HHS press release, continuous coverage provides peace of mind to families with the assurance that “their children will have uninterrupted access to health care coverage for a year, regardless of any changes in their family’s financial circumstances.”

According to the HHS press release, continuous coverage for children has been shown to reduce financial barriers to care for low-income families and promote health equity. Stable coverage also enables health care professionals to develop relationships with children and their parents, track children’s health and development, and help families avoid expensive emergency room visits.

People lost their coverage this past summer when states began disenrolling people after the Consolidated Appropriations Act, 2023 was signed into law in December 2022. That Act ended continuous enrollment effective March 31, 2023. The continuous enrollment provision was a part of the Families First Coronavirus Response Act mandating Medicaid coverage through the end of the COVID-19 public health emergency. In an article on its website, KFF, a health policy research organization, pointed out that Medicaid enrollment has grown substantially compared to before the pandemic, and the uninsured rate has dropped.

According to KFF’s Medicaid Enrollment and Unwinding Tracker, 73% of all people disenrolled had their coverage terminated for procedural reasons, such as not completing paperwork by the deadline. In many cases, programming errors caused automatic renewals to occur at the family rather than individual level. Because of those errors, the individuals who qualified for automatic renewal had their coverage terminated if other members of their family did not respond as needed. In the CMS letter, states were directed to retroactively restore Medicaid coverage to children and others who had lost coverage and to halt terminations until their systems were fixed.

The computer issues affected people in 29 states and the District of Columbia. Medicaid officials estimated that in many of the states, fewer than 10,000 people were affected by the errors. In Pennsylvania and Nevada, however, more than 100,000 people in each state were affected.

Kate McEvoy, executive director of the National Association of Medicaid Directors, said in a PBS NewsHour article that automated eligibility systems vary by state and can be technically challenging and costly to change. In that same article, Daniel Tsai, director of the CMS Center for Medicaid and Children’s Health Insurance Program Services, said that some states expect to complete system improvements before the end of September while others expect it to take several months.

Sherri Alms is the freelance editor of The OARacle, a role she took on in 2007. She has been a freelance writer and editor for more than 20 years.