Understanding unwinding data

First and foremost, Medicaid is about providing eligible people with health insurance coverage  and access to a comprehensive array of health care services. As leaders of this program in all 56 states, territories and the District of Columbia, our primary focus is – and has been for more than year – setting up systems to help eligible members keep their health insurance. That’s why it is critical for all of us to understand and be informed by the data behind our efforts as that work evolves over the year-long period of unwinding. Being responsive to what we learn at each stage will help to ensure that those eligible retain coverage and those ineligible can transition to an employer-sponsored health plan or coverage on the state or federal marketplace.

Here’s what you need to know to understand the early Medicaid redetermination data.

1. States are engaging in unprecedented levels of outreach to existing Medicaid members.

States understand their critical role in outreach to Medicaid members. Even before the official start of redeterminations, states were running digital, mail and text campaigns urging current members to ensure that their contact information is up-to-date. These campaigns also urged members to respond to requests from their Medicaid agency when they received their redetermination packets in the mail. State call centers and Medicaid managed care plans are now not only answering incoming calls from current members, but also reaching out to those who have not responded. All states are required to do everything possible to use internal information to automatically reenroll members without paperwork, and this is helping an increasing number of people. In addition, states are partnering with community-based organizations, providers, hospitals, and health insurance plans in an attempt to make sure that no one falls through the cracks.

2. How states opted to prioritize the order of Medicaid members undergoing eligibility checks in any given month dramatically impacts the numbers from that state.

Some states have started the process with those whom they anticipated are now ineligible. Others are simply aligning their work to parallel their typical redetermination rates and timelines over the course of the year. This reality makes it difficult to look beyond individual state numbers for broader trends. Many states have developed public-facing dashboards that provide helpful, real-time information on what is happening in an individual state.

3. Procedural terminations (e.g. people being removed from Medicaid for administrative reasons including non-response to Medicaid agencies) are one important metric to measure unwinding success, but it is not one that can be understood based on a single number.

Federal Medicaid requirements require that states verify eligibility of members – this oftentimes requires Medicaid members to respond to request for information. It has been the goal of Medicaid agencies across our country to limit the number of people who lose coverage because they fail to respond to requests for information. But early data releases cannot yet capture what these initial rates mean and reducing it to one global number ignores the reality that there are many different scenarios that are occurring. Among these is that individuals who have become ineligible for Medicaid are moving on to other health insurance plans through their employers or federal or state marketplace plans and have opted not to respond. Because we will not have data on uptake of these other types of coverage for several months, it will take time to more meaningfully understand the overall rate of procedural terminations.

4. States are required to observe extensive procedural protections for people at risk of losing coverage.

Throughout the current eligibility redetermination process, all states are required to ensure protections for members, including the types of outreach contacts that are required, fair hearing processes and a new 90-day reconsideration period during which people can be reinstated to coverage.

5. Medicaid is always open for new enrollment or reenrollment.

It is very important that we remember, unlike private insurance which has open enrollment periods with limited exceptions for life events, Medicaid is always available to people who need it and qualify for the program. Even if a person loses eligibility because they have not been able to respond timely or only learn they have lost eligibility when they visit the doctor, they can be restored to eligibility at any time.