Data helps some states boost renewals amidst Medicaid unwinding

Now that the COVID-19 public health emergency declaration has ended, states are engaged in the massive task of reviewing the eligibility of the nation’s roughly 93 million low-income people on Medicaid. Based on the most current data from 45 states and the District of Columbia, more than 5 million people have been disenrolled so far and, in 42 states and the district, about 8.3 million recipients’ coverage has been renewed.

The unwinding process has received a lot of media attention for the number of disenrollments, which varies widely across reporting states due to the vastly different approaches they are taking in terms of the amount of time they are conducting the reviews in, how they are verifying information and the methods they are using to warn people of possible or actual changes to their coverage. 

When it comes to verifying information, there is one approach that some agencies are leaning into. States like Missouri are conducting ex parte renewals, or those that use available data sources to redetermine eligibility without requiring information from the individual. 

The Missouri Department of Social Services, or DSS, is using a so-called insight engine, which the department describes as a system that taps into more than a dozen electronic sources to collect data to verify income, child support payments, unemployment benefits and out-of-state public assistance, as well as information from the agency’s Family Support Division’s eligibility systems. 

With access to reliable information on which to base their ex parte decisions, Missouri has boosted the number of automatic renewals for MO HealthNet, the state’s Medicaid program, Melissa Wolf, deputy director of the Family Support Division at DSS, said during a recent webinar. Electronic verification, she added, “is less of a burden on the participants and on staff.”

And alleviating that burden should be at the heart of any agency’s approach to the unwinding process, said Jennifer Wagner, director of Medicaid eligibility and enrollment at the Center on Budget and Policy Priorities. 

Currently, the burden lies mainly with Medicaid applicants and eligibility caseworkers. For instance, applicants may be receiving confusing notices about the end of coverage and next steps. Eligibility workers, on the other hand, are often having to complete paper renewals because of outdated technology systems—a process that is rife with opportunities for mistakes.

“We can make better choices here that protect everybody and really put the burden on the system rather than the system putting the burden on the clients and the workers,” Wagner said.

She listed three main areas of concern agencies should monitor when they rely on technology for unwinding. 

Two are low ex parte rates and higher rates of procedural terminations, which often happen when people who are eligible for benefits fail to respond to renewal notices.

Indeed, earlier this month the Centers for Medicare & Medicaid Services sent letters to all states reviewing their respective data. For some, the agency highlighted concerns regarding a high share of disenrollments for procedural (vs. eligibility-related) reasons, long call center wait times and application processing times above the 45-day standard applicable to most enrollees.

Low ex parte rates and higher rates of procedural terminations are leading to the third area of concern that Wagner listed:  backlogs. “We know that some states and local governments were struggling to keep up with applications before the pandemic provisions ended, before unwinding began,” she said. That results in longer call center wait times and lower customer experience, she added.

In addition to their approach to ex-parte renewals, Missouri has emphasized retraining employees as a way to get at backlogs and long wait times. “You just forget how to do something when you haven’t done it for three years,” Wolf said of efforts by the agency to help staff get back up to speed after the pandemic put redeterminations on hold. Plus, many of the workers the state hired to help with the unwinding had no experience on which to build.

To track its Medicaid renewal performance, DSS launched a public dashboard on July 27 to improve transparency about eligibility determinations for MO HealthNet.  

One reason for creating the dashboard is that “it just seems to be a struggle to explain and make everyone understand [the data], especially if you’re not in this business and you don’t live and breathe it every day,” Wolf said.

Backlogs, staff and skills shortages, budget constraints, and management of the program “are all issues that have been prevalent for a long time in Medicaid,” Wagner said. “The positive spin on this is that unwinding is really bringing increased attention to it. The good thing about this is that … these lessons we’re learning can [apply] beyond unwinding and help serve people well in the future.”