As the pandemic draws to a close - or at least the official state of emergency ends - our nation is re-adjusting Medicaid rules yet again. Continuous enrollment, a program that saw many thousands of Americans retain Medicaid coverage during the pandemic, is officially over and a new plan - nicknamed Medicaid “unwinding” - is underway. State governments refrained from evaluating Medicaid eligibility for roughly three years under the state of emergency, leaving many Medicaid members on the state roster despite not being able to meet income requirements. Now, as those accounts are subjected to a close “redetermination,” it’s expected that many will lose coverage as states look to slash public health spending. It’s estimated that about one in six people who lose coverage during the unwinding process will be left uninsured. 

Today, let’s look at how Medicaid unwinding is playing out in Wisconsin, South Carolina, Oregon, Oklahoma, Connecticut, Utah and Iowa. 

Note: If you’re interested in other states, check out our post on Medicaid Unwinding and State Behavioral Health in Montana, Minnesota, New York, Arizona, Colorado, Tennessee, and Washington or Medicaid Unwinding and State Behavioral Health in Indiana, New Jersey, Kentucky, Massachusetts, North Carolina, Louisiana and Virginia.

Wisconsin May Lose Thousands of Medicaid Patients During the Unwinding Process

Wisconsin is not a medicaid expansion state, which means that Medicaid unwinding is likely to hit Wisconsinites harder than most other states. 

The state estimates that there are over 1 million people in Wisconsin who need to reapply for Medicaid during the unwinding process. During the pandemic, Wisconsin’s Medicaid rolls expanded by 32% to include more than 340,000 new patients. The coming redeterminations will begin in June 2023 and continue on into May 2024. 

Unlike other states, Wisconsin is pre-assigning due dates so that members know in advance when their applications will be reviewed during the unwinding process. Wisconsin plans to text reminders to members 45 days before their applications are due. You can read more about Wisconsin’s unwinding plan in the Wisconsin Department of Health Toolkit.

South Carolina Medicaid Unwinding to Review Eligibility of 1.3 Million People

South Carolina expects the unwinding process to take 12 months. The state will begin sending out annual review forms beginning in April 2023 and will continue until March 2024, when all members will have been subjected to a redetermination notice. 

There are about 1.3 million people enrolled in Medicaid in South Carolina, which is not a medicaid expansion state. Because South Carolina has not adopted medicaid expansion, its residents are vulnerable to a notorious “coverage gap” that means neither state nor federal assistance is available to those of a certain lower income bracket. The state is encouraging those who are removed from the Medicaid program to investigate workplace insurance plans as well as marketplace plans found on healthcare.gov. 

Oregon to Soften the Blow of Medicaid Unwinding with Bridge Health Care

Oregon has begun to undertake a massive redetermination drive to address the whopping 1.4 million people in the state whose Medicaid accounts need re-verification. 

Medicaid patients in Oregon have two things going for them to buffer the effects of the unwinding program: Medicaid expansion and the Bridge Health Care Program. This program, created by HB 4035, will expand Medicaid coverage to those who are between 138 and 200% of the Federal Poverty Level. 

Oregon will not make specific renewal dates available to members in advance. The state instructs members to wait for notification in the mail sometime between April 2023 and January 2024. Oregon will be sending new batches of redetermination communication to members each month. Members must respond to any requests for information within 90 days of receipt of these renewal letters. 

Oklahoma Medicaid Unwinding Plan Includes 3 Different Eligibility Notices

Oaklahoma’s Medicaid Unwinding Toolkit outlines the state’s plan to send three notices to all Medicaid members as part of their Medicaid unwinding plan. Those notices are: 

• An initial letter with a specific end date for benefits 

• A second reminder sent 45 days prior to the end date 

• A third notice sent 10 days before the loss of eligibility

Although Oklahoma is a Medicaid expansion state, the Oklahoma Health Care Authority still estimates that more than 200,000 SoonerCare members may lose their coverage during the unwinding period. 

Connecticut Medicaid Unwinding Program Relies on Residents to Update Their Contact Information

Connecticut is urging all Medicaid members to update their contact information via the Access Health CT login page, particularly those members who have experienced a change of address within the last three years. The state plans on sending renewal notices to members 45 days before their coverage is due to end. While some applications may be renewed “passively” many members will need to respond to these notices with updated information in order to retain their health insurance coverage. All in all, the state expects to see roughly 434,000 enrollees to be disqualified from eligibility during the unwinding process. 

Utah Will Make Review Dates for Medicaid Unwinding Program Available in Advance 

Unlike some states, Utah is making Medicaid unwinding application review dates available to members in advance. Utahns can check myCase to see when action will be taken on their membership eligibility case. In general, Utah intends to wrap all redeterminations within a 12 month period. With a membership base that grew 64% in size during the state of emergency, Utah saw its Medicaid program expand faster than the vast majority of states in the nation. 

Iowa’s Medicaid Unwinding Program Will Take Place in Four Phases

Iowa is conceptualizing their unwinding timeline in terms of four phases, with each phase assigned a different color: green, blue, red and yellow. During the green phase, members are urged to update their contact information. During the blue phase, the government intends to expand awareness about the end of continuous enrollment for current enrollees. During the red phase, workers will help members complete all of the necessary paperwork to retain membership. During the yellow phase, workers will help those disenrolled from Medicaid to find alternative sources of health coverage, whether that’s through an employer plan or through the ACA marketplace. 

More than a quarter of Iowans are currently enrolled in Medicaid. 

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