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Only four months left in Medicaid ‘unwinding.’ Who is losing coverage?

Maryland Department of Health data shows that more than 100,000 Marylanders have lost Medicaid coverage since May, when pandemic-era policies expired. Photo by Danielle E. Gaines.

Since May, over 245,000 Marylanders have lost health care coverage from Medicaid, an insurance plan aimed at low-income residents, during a eligibility review period often referred to as “Medicaid unwinding.”

Eight months into the unwinding period, a new report from Maryland Department of Health shows that some areas in Maryland are retaining Medicaid coverage while some populations are losing it. The department says it will use the data to target harder to reach populations in the remaining four months of the unwinding period.

In April, the department began the immense task of re-evaluating the eligibility of nearly 1.8 million Marylanders who were on Medicaid to determine if they still qualified for the plan.

During the COVID-19 pandemic, people were not required to reapply annually for Medicaid, which is a joint federal-state program. The goal was to insure as many people as possible during the global health emergency.

Now that the public health emergency has ended, Medicaid enrollment is no longer automatic and the Maryland Department of Health is conducting Medicaid redeterminations in monthly phases.

>> TALK TO US: Maryland Matters wants to hear from people affected by changes in their health care coverage during the Medicaid unwinding process. If you would like to share your story, click here.

According to a January report with data spanning from March through December 2023, the Department of Health has processed about 1.08 million Medicaid enrollees who were up for redetermination. Medicaid disenrollments began in May.

So far, about 751,000 Medicaid enrollees who were evaluated from May through December retained their enrollment, or about 69%.

About 93,600 people were determined to no longer qualify for Medicaid coverage. They either earn too much to qualify for the low-income health care program or have aged into Medicare, the federal health care plan for retirees.

Those who no longer qualify for Medicaid due to income are encouraged to find a private plan on the state’s health insurance market place called the Maryland Health Benefit Exchange.

But part of the equation are a percentage of Medicaid enrollees who get disenrolled for “procedural reasons,” meaning that they never sent in an application for reevaluation or they started one but did not complete the process.

Those disenrolled for procedural reasons might still qualify for Medicaid, but the state does not know because the recipient did not finish the reapplication process. The number of procedural terminations matters to the Department of Health because they want to ensure that eligible Marylanders retain health care coverage.

In August, The U.S. Centers for Medicare and Medicaid Services (CMS) instructed states to suspend terminating Medicaid disenrollments for procedural reasons, as the federal agency learned that some enrollees were inappropriately losing coverage.

Federal officials warn of ‘inappropriate’ Medicaid terminations; Maryland, other states told to review redetermination process

Procedural terminations were paused in August, September and October, at the recommendation of CMS. The procedural terminations resumed in November, and that data was available as of December.

“A participant who would have procedurally disenrolled in August or September was moved to November 30, 2023, while a participant who would have procedurally disenrolled in October was moved to December 31, 2023,” according to a Tuesday email from the Department of Health. “This enabled Medicaid to distribute the renewals without causing a backlog.”

According to the January report, there were about 34,300 people who were disenrolled in November for procedural reasons, and 51,000 disenrolled in December. Before the pause, about 66,000 Marylanders were disenrolled from procedural reasons from May through July, for a total of about 151,000 disenrolled for procedural reasons in 2023.

Additional outreach

The department is looking at demographic and geographic data for procedural terminations from May through November to see which populations may not know that Medicaid re-enrollment is no longer automatic or struggle to complete their application.

In May, the health department launched the Medicaid Check-In informational campaign, to make Marylanders aware of the unwinding period and encourage recipients to update their contact information with the state, so that they would be notified of their redetermination period.

The department notes that certain groups are retaining coverage at higher rates after eligibility reviews.

Those groups include children ages 18 and younger as well as Black populations, according to demographic data as of November 2023. But adults under age 65 are experiencing more terminations, the report notes.

“MDH is targeting additional outreach to certain zip codes with high procedural disenrollment rates,” according to data notes from the department.

Additional outreach efforts include more frequent radio advertisements and adding more information at bus shelters and light rail advertising. The department plans to add billboard in parts of western Maryland.

Terminations can also vary by geographic areas. Some zip codes in Prince George’s County, Montgomery County and parts of Western Maryland are experiencing more terminations, while residents of Baltimore are retaining Medicaid coverage, according to the report.

“MDH will continue to assess disenrollment data and strategize on how to reach certain populations accordingly,” the report said.


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Only four months left in Medicaid ‘unwinding.’ Who is losing coverage?