Federal officials have major errors were discovered with the systems and procedures that some states use to verify eligibility for Medicaid, potentially leading to a large number of children losing health coverage despite still being eligible for it.
State agencies are “repealing” a policy during the pandemic that allows people to keep their health insurance coverage through Medicaid, the federal-state joint program for low-income Americans , without regular eligibility checks.
After that rule in April, at least a million children lost coverage, researchers found, despite having significantly higher eligibility limits than adults.
In a letter faced with state Medicaid agencies, Daniel Tsai, a senior official at the Centers for Medicare and Medicaid Services, warned that technical errors could be to blame for many disenrollments.
Mr. Tsai told reporters at a press briefing on Wednesday that the problem was “a very specific system glitch that we think has enormous implications for eligible children and families who maintain coverage.”
Many states conduct so-called “ex parte” renewals, or automatic checks that rely on databases, such as state wage records, to determine whether people are still eligible for coverage. of Medicaid.
States are required to check the eligibility of recipients on a case-by-case basis. But after implementing automatic renewals, some states appear to have sent out renewal forms requesting information for all household members and disenrolled everyone if the forms weren’t returned, including those who should be considered eligible through the ex parte process, Mr. Tsai wrote in the letter.
Children may be disproportionately punished by this practice, officials said Wednesday.
The administration ordered states that identified this error to fix their eligibility systems, pause withdrawals and reinstate those affected by the errors.
The letter amounts to one of the most confrontational actions taken by federal officials since the beginning of the unwinding, which led to more than 5.5 million people losing coverage, according to state data analyzed by KFFa health policy research organization.
Mr. Tsai declined to reveal the states where officials discovered the problem but said state agencies have two weeks to investigate it and report back to the federal government.
A spokesman for Mr. Tsai’s agency said more than a dozen states believed they had been affected.
From the beginning of the pandemic until the beginning of April, states were not allowed to kick people off Medicaid under a provision in a 2020 congressional coronavirus relief package.
That law, which offered additional federal funding to states, increased enrollment in the program to record levels. Earlier this year, 93 million people were enrolled in Medicaid or the Children’s Health Insurance Program, up from 71 million before the pandemic.
Researchers at the Georgetown University Center for Children and Families estimated before the unwinding began more than half of the children nationwide covered by Medicaid or CHIP.
Ending the requirement to maintain coverage has proven disastrous for low-income families and children. At least 1.1 million children are believed to have lost Medicaid coverage since the policy ended, according to the data from 15 states analyzed by KFF.
Some states have not yet published data disaggregating coverage losses by age, giving researchers a limited look at the toll on children.
Children have higher, or more generous, eligibility thresholds for Medicaid and CHIP enrollment, so they are expected to remain on the rolls in greater numbers. Public health experts have feared for weeks that the loss in coverage was the result of mistakes by state Medicaid agencies.
Joan Alker, the executive director of the Georgetown center, said that children on average are eligible for up to 2.5 times the federal poverty level through Medicaid or CHIP. When they lose coverage, he added, they often have nowhere else to turn to health insurance.
“Children are not expensive to cover, but they regularly use care,” he said. “They often have ear infections, asthma, things that are very treatable but require them to have access to care.” The gaps in coverage, added Ms. Alker, can be life threatening.
Loss of coverage in children is led by Texasa state that did not expand its Medicaid program under the Affordable Care Act and hosts a large population of Medicaid-insured children.
More than 600,000 people in Texas lost Medicaid coverage during the unwinding — by far the highest total of any state.
In Kansas, more than half of Medicaid beneficiaries who lose coverage are children, according to KFF. Kate Gramlich, the project manager of Cover Kansas, a group that helps people in the state enroll in health plans, said Medicaid has become especially important to low-income people in rural areas.
“Jobs may be scarce or not paying a living wage,” he said. “Many parents rely on Medicaid in Kansas to have any kind of health benefits for their children.”
Health care advocates in the state, Ms. Gramlich, pushed Medicaid officials to use automated eligibility checks during the unwinding process. “We’re not considering potential downfalls,” he said.
