New Methodology Helps Facilitate Medicaid Renewals

When the end of the COVID-19 pandemic led to the end of the moratorium on Medicaid disenrollments, states faced a daunting challenge:  how to redetermine eligibility for 90 million people on their Medicaid rolls.

The challenge grew even greater when it appeared that significant numbers of people were losing their Medicaid eligibility not because they no longer met the program’s eligibility criteria but for procedural reasons such as inability to  gather the information needed to demonstrate eligibility, incomplete applications, or missing application deadlines.

To address this problem, the Centers for Medicare & Medicaid Services tried a different approach, working with four states to place greater emphasis on what are known as “ex parte renewals” – using existing sources, such as income data from other government benefits programs and wage data from state agencies.  States already used ex parte renewals but CMS chose for extra attention four states that together accounted for nearly 30 percent of the Medicaid population – California, New York, South Carolina, and Wisconsin – to improve how they mined existing sources for data they were having difficulty obtaining from applicants.  Sometimes those efforts were undertaken manually and in some cases the states, with help, were able to automate some of this work, producing faster and better results.

The result:  according to a new analysis, the four states saw their ex parte renewals exceed those in other states by 21.6 percentage points, their overall renewals increase 7.7 points, and their procedural denials decline 8.3 points.

Another result:  fewer people lost their access to Medicaid-covered services for reasons having nothing to do with their eligibility for those services.

Learn more about the challenges that CMS and the states faced, how they addressed them, and the implications of these efforts for future Medicaid eligibility determination efforts from the Health Affairs study “Interventions To Automate Medicaid Renewals Reduce Procedural Denials And Increase Coverage.”