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Medicaid ‘unwinding’ leading to more health care purchases on Md. insurance marketplace

The Maryland Department of Health is reevaluating the eligibility of 1.8 million Marylanders on Medicaid in a phased process after a COVID-era policy that didn’t require annual reenrollment expired. Photo by Danielle E. Gaines.

The massive Medicaid eligibility redetermination period — often called “unwinding” — has contributed to more Marylanders buying individual private health care plans through the state’s insurance marketplace, according to a Monday budget hearing in the House Appropriations Subcommittee on Health and Social Services.

“All categories we have had double digit increases. Our new enrollments were up 64%,” Michele Eberle, executive director for the Maryland Health Benefit Exchange, told the subcommittee. “We attribute that to multiple things — primarily the Medicaid unwind, where we know people who were on Medicaid and now moving off of Medicaid, are no longer eligible, found relatively affordable insurance in the individual marketplace.”

The “unwinding” of Medicaid enrollment is due to a COVID-pandemic era policy that suspended the annual renewal process for Medicaid enrollees to continue health care coverage year to year. From when suspension began in March 2020 through March 2023, states were prohibited from disenrolling people from the joint federal-state program that provides a health care plan for low-income households.

Once the federal public health emergency ended, the Maryland Department of Health began a 12-month process of evaluating the eligibility of roughly 1.8 million Medicaid enrollees, and discontinuing coverage for those who no longer qualify or who did not complete the reapplication process.

Each cohort of Medicaid redeterminations have a two-month timeframe to complete their reapplication process once they are notified by the Maryland Department of Health.

With only three months left in the 12-month redetermination process, Eberle suspects that the Maryland Health Benefit Exchange will continue to see growth during the final rounds of disenrollments this year.

“We do anticipate we’re going to have continued growth,” she said. “The public health emergency unwind, the state of Maryland took the full twelve months to do the unwind program…we’ve sent our first notices out for the May disenrollments. So we’re coming down to the end of that.”

According to an analysis from the Maryland Health Benefit Exchange, from November to mid-January, there was a large increase in Medicaid disenrollees who purchased a qualified health plan (QHP), which are insurance plans certified by the exchange.

“There were 14,089 individuals statewide that were no longer eligible for Medicaid enrolled in a QHP during open enrollment between November 1, 2023, through January 15, 2024, a 375% increase from 2,966 individuals in calendar 2023,” according to the analysis.

>> 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.

Every month, the Maryland Department of Health provides data updates on Medicaid redeterminations. The most recent update was published in February for the January redetermination period.

Per the January data, there were approximately 1,694,000 Marylanders enrolled in Medicaid, down from about 1,787,000 million in March 2023, before Medicaid unwinding began in the state.

There were 126,913 Medicaid redeterminations due to be processed by January.

Of those the Maryland Department of Health found that 87,522 Medicaid recipients could continue to receive health care coverage through the federal program. Another 6,488 redeterminations were still pending review, as of the February update.

There were 33,814 Marylanders disenrolled from Medicaid in the January redeterminations. About 16% of January disenrollments, or 5,478 people, were due to ineligibility either by earning too much money to qualify or by ageing out of the program.

Those who are no longer eligible due to income reasons are encouraged to shop on the Maryland Health Benefit Exchange for an individual private plan that best suits their financial situation.

However, a vast majority of those who lost Medicaid coverage were disenrolled due to “procedural terminations,” meaning they never submitted a renewal request or did not complete the renewal process.

There were 28,336 former Medicaid recipients disenrolled in January for procedural reasons — almost 84% of all January terminations.

Those disenrolled for procedural terminations may still qualify for health care coverage under Medicaid.

Anyone who is disenrolled, perhaps because they may earn too much, can look for a health care plan on the Maryland Health Benefit Exchange. But the Department of Health can’t tell unless Medicaid enrollees complete the renewal process.

The Department of Health recently announced expanded efforts to reach out to communities with the highest rates of procedural terminations to ensure that the Medicaid recipients are aware that they have to reenroll in Medicaid and so they can reapply in time.

The Department of Health has issued over 1.2 million Medicaid redeterminations from April 2023 through January 2024 according to the most recent update.


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Medicaid ‘unwinding’ leading to more health care purchases on Md. insurance marketplace