Medicaid 'unwinding' creates challenges

Opinion editor's note: Editorials represent the opinions of the Star Tribune Editorial Board, which operates independently from the newsroom.

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The plight of a Florida family illustrates the high stakes involved in "Medicaid unwinding" — the massive effort underway nationwide to redetermine medical assistance eligibility in the COVID pandemic's aftermath.

During this historic public health emergency, regular income eligibility checks for publicly funded medical programs were suspended to ensure access to care. But it's now time for these checks to resume. The Florida family, whose story was documented by the nonprofit Florida Health Justice Project, is an example of what can go wrong as officials process massive amounts of paperwork.

The family lives in Duval County, which spans the Jacksonville metro area. They rely on medical assistance for monthly injections to treat a child who suffers a serious gastrointestinal condition. But the forms to determine their ongoing eligibility were sent to an old address. The boy lost coverage even though his family remained eligible.

Avoiding alarming scenarios like this is paramount as the unwinding continues into next year. While Minnesota has taken a commendably careful approach, the first report card on how we're doing just came out. More hard work is in order to prevent red tape from cutting off coverage for eligible enrollees here, especially children.

The Minnesota Department of Human Services (DHS) shared the report card data on Wednesday. It covers the first group of medical assistance enrollees asked to fill out and return forms to determine eligibility.

Some background: About 1.5 million Minnesotans rely on public medical programs. To make processing the paperwork more manageable, the agency divided enrollees into 12 groups based on the month when they became eligible for aid.

Those in the July group were up first. Of those 97,900 individuals, 59,700 (61%) maintained coverage because their eligibility was renewed or their coverage extended thanks to a sensible policy DHS enacted for the disabled, blind or those over 65.

But that still leaves a sizable number — 38,200 — who lost coverage. In this group, 5,600 who submitted renewal forms were found ineligible, which may be a positive development because they could have found employer-provided health insurance.

More troubling is the far larger group — 32,600 people — who lost coverage for procedural reasons, such as families not returning paperwork with required information.

DHS, to its credit, had age and demographic breakdowns of this group's members. It's alarming that 41.4% of them were 17 or younger, a finding that should spur stronger strategies to get parents to return required information. Race and ethnicity data should also inform other efforts to ensure that eligible enrollees with disadvantages can maintain coverage.

With other widespread variation in how states structure health care programs, it's hard to do an apples-to-apples comparison of how Minnesota is doing. That the unwinding effort is just getting underway here also complicates this.

Some other states rushed into re-determination earlier this spring. "At least 4,118,000 Medicaid enrollees have been disenrolled as of August 9, 2023, based on the most current data from 42 states and the District of Columbia," according to KFF, a health care nonprofit.

Still, it's worth taking an early look at available metrics. "Across all states with available data, 75% of all people disenrolled had their coverage terminated for procedural reasons. There is also wide variation in rates of procedural disenrollments across states reporting this breakout, ranging from 96% in Nevada and New Mexico to 23% in Maine," KFF reports.

Of the Minnesotans disenrolled so far, 85% had coverage stopped for procedural reasons.

In an interview with an editorial writer, DHS Commissioner Jodi Harpstead applauded efforts by counties, health insurers, insurance navigators, pharmacists, state officials and others in the state's health community to help eligible enrollees stay covered. She also noted that this is the first group of Minnesotans to go through this. Experience and growing awareness should reduce the ranks of those who don't return information.

Harpstead also noted that the people who missed their renewal deadline should still return their information. They may be able to re-enroll or qualify for retroactive coverage. For more information, go to mn.gov/dhs/renewmycoverage/.

Minnesota has taken a thoughtful approach to the great "unwinding." But this early report card shows how daunting a task it is, with many enrollees moving or becoming unfamiliar with the redetermination process during the three years of continuous enrollment. Even stronger teamwork and further innovation are necessary to keep those eligible from falling through coverage cracks.