With Pennsylvania’s historically low use of conducting renewals on an ex parte basis, the CMS requirement is welcome news in supporting much needed, long-term system corrections. However, a solution is needed now to correct the error and get children reconnected to coverage. What is the status and how is the process affecting children’s coverage? DHS created an online data tracker to share the results of the unwinding process on a month-by-month basis. xii With about a third of the total children in the unwinding group reviewed as of September 2023, more than half (57%) of children have maintained their Medicaid coverage. However, that number should be higher because children are losing coverage despite remaining eligible. Over half the children who lost Medicaid coverage during the unwinding process are due to procedural or paperwork reasons, not eligibility. It is alarming that a large portion of children (51%) who lost Medicaid coverage during the unwinding process is because of administrative or paperwork reasons rather than ineligibility. These children very likely remain qualified and otherwise would still have health insurance if not for procedural problems. The automated renewals error, as noted above, is a likely reason for this high percentage. One way to counter churn, i.e., these unnecessary gaps in children’s coverage, is through continuous eligibility (more on page 15). The DHS data tracker just began to report the number of children who returned to Medicaid within four months of losing their coverage. Unfortunately, it is remarkably low with only 2% of children returning to Medicaid within four months of closure.
Does the recent CMS warning to states to fix automated renewals during unwinding impact PA? Yes. In response to the August 30th letter from the Centers for Medicare & Medicaid Services (CMS) warning all states to assess and fix their eligibility systems so eligible children and their families can remain enrolled in Medicaid, Pennsylvania is identified as one of the 30 states with an error. The issue is how some states have been conducting automated renewals, also known as “ex parte” renewals, that are causing improper disenrollments for those still eligible, especially children. CMS believes the problem lies in how states conduct automated renewals at the household level instead of at the individual level, most likely because parents have different eligibility requirements than their children. If parents’ eligibility couldn’t be completed automatically at the household level, then states’ systems weren’t completing it for children, resulting in loss of coverage. CMS is requiring all states with the error to take immediate action. However, the remedy is being determined by each state and Pennsylvania is all too slowly figuring out how many have been impacted and the timing for reinstating coverage. Given the preliminary estimates that this error disproportionately impacted children, we urge DHS to immediately reinstate all children who incorrectly lost coverage.
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November 2023
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