Georgia is one of 30 states that was flagged by the federal Centers for Medicare and Medicaid Services late last month for its improper handling of automatic renewals, as the state continues to reevaluate eligibility under Medicaid and the Children’s Health Insurance Program.
During Medicaid unwinding, automatic renewals, also known as ex parte renewals, are supposed to make it easier for eligible people to keep their Medicaid by allowing agencies to use existing income and demographic information to determine people’s eligibility.
It’s one of several waivers states can apply to their unwinding plan. Read more about Georgia’s adopted waivers here.
But by mid-September, an error in this process removed Medicaid coverage from almost 18,000 adults and kids in Georgia, according to the Department of Community Health. They’ve since had that coverage reinstated, DCH said, with assistance from CMS.
Other states saw as many as 100,000 people affected by noncompliance with guidelines for automatic renewals.
Here’s what happened
States are supposed to assess people’s Medicaid and CHIP eligibility at an individual level. By doing so, public health agencies can ensure that only those no longer eligible for the health insurance programs have their coverage rescinded.
Instead, the 30 states flagged by CMS have or had been conducting renewals at a household level. That resulted in some family members losing coverage even if they could have maintained it through automatic renewals, simply because others didn’t turn in the right information.
“It is something that we’re very concerned about, because ex parte renewals are the best way to help families renew their coverage, it’s the least burdensome route for families,” said Brittney Newton, senior policy analyst for Voices for Georgia’s Children.
Georgia’s U.S. senators and other congressional members expressed their concerns about the issue too, in a letter sent to Secretary Xaviar Becerra of the Department of Health and Human Services and CMS Administrator, Chiquita Brooks-LaSure.
Ongoing challenges
Nationally and in Georgia, far more people have been renewed through the ex parte process rather than by turning in renewal forms.
Still, since early on, the unwinding process has proved confusing for many people.
Newton said it still is. Many families she’s heard from aren’t aware they’ve lost coverage until they need it.
“Sometimes they’ll go to refill a prescription or go to the doctor, and then that’s when they find out that they no longer have coverage,” Newton said.
Those who do lose coverage but are still eligible have 90 days to reach out to the state. Georgia also has an appeals process for people who feel they’ve been wrongly denied coverage.
Since the start of Medicaid unwinding in Georgia, almost three times as many people have lost their health insurance coverage in Georgia because of procedural reasons rather than changes in eligibility.
“The issue is just the volume,” said Sheryl-Anne Murray, vice president of Market Operations for CareSource, one of three primary Medicaid providers in Georgia.
But while the volume of people going through redetermination is one thing — just shy of 3 million people in Georgia are expected to go through redeterminations — barriers to reaching those in rural areas or those without stable housing is another, Murray said.
“We’re pushing, pushing, pushing the information out there, text messages, phone calls, emails, advertisements,” Murray said. “We’re pushing to make sure members are aware of this and they need to act.”