Unveiling the Insights of Early Medicaid Unwinding Data (Updated)

The early Medicaid Unwinding data reveals variation in disenrollment rates across states. Out of the 12 states that have released their numbers, over half a million enrollees have been disenrolled. Florida alone accounts for nearly 250,000 disenrollments. Among the nine states reporting both total renewals and disenrollments, the rate ranges from 54% in Florida to 10% in Virginia, with a median rate of 34.5%.

The early data also reveal a high percentage of procedural disenrollments in some states that are closing medicaid coverage, where the individuals are disenrolled due to incomplete enrollment processes. States like Arkansas, Indiana, Florida, and West Virginia report procedural Medicaid disenrollment rates exceeding 80%, while Iowa reports a rate of nearly 55%. This raises concerns, especially considering a recent KFF survey indicating that a majority of current Medicaid enrollees did not experience changes in income or circumstance change that would make them ineligible for Medicaid. The survey suggests that many individuals whose coverage was terminated for procedural reasons likely remain eligible.

As more data becomes available, key questions arise. First, the variation in renewals prioritization among states may be driving the differences in disenrollment rates. Some states, such as Arkansas, Idaho, Iowa, and Florida, primarily focus on renewing individuals deemed ineligible or non-responsive during the continuous enrollment period, resulting in higher disenrollment rates. Other states, like Indiana, Nebraska, and Virginia, adopt a time-based approach, conducting renewals based on individuals’ renewal dates. Additionally, the effectiveness of state communication and outreach efforts should be assessed to lower procedural disenrollment rates. The KFF survey reveals that many Medicaid enrollees are unaware of the resumption of disenrollments and lack previous experience in actively participating in renewal processes.

Tracking the ability of newly uninsured individuals to re-enroll in Medicaid is crucial, as a significant portion may still qualify for coverage. Currently, Pennsylvania is the only state reporting re-enrollment data within four months. Furthermore, it is important to determine if individuals deemed ineligible for Medicaid can obtain alternative coverage through ACA Marketplaces or employers. While Kentucky and Pennsylvania include this information on their state dashboards, other states and the federal Marketplace, Healthcare.gov, have not yet provided data.

The response from states and CMS to the early data remains uncertain. Some states have taken steps to minimize procedural disenrollments, such as Idaho pausing disenrollments due to technical issues and Iowa conducting a thorough review of open cases. CMS is working with states on compliance issues and has the authority to require pausing procedural disenrollments if necessary. While this initial data raises concerns, further months of data will be necessary to assess whether there are systemic issues in how states conduct renewals or if the high disenrollment rates are temporary. It will be important to continue examining the impact of policy variation and unwinding implementation on disenrollment rates in the coming months.