The “Medicaid unwinding” process has begun and its effects are starting to be felt in every state in the nation, particularly in behavioral health clinics throughout the United States. Due to the state-by-state nature of Medicaid plans, it’s what happens at the state level, rather than the federal level, that determines much of what the contours of the unwinding process will look like on the ground for addiction treatment patients and other high risk populations.
Some things are certain, though. We know, for example, that somewhere between 5 and 15 million people will lose their state-backed health insurance coverage in the next 12 to 14 months. Most of these people will be disqualified on an income basis, while others will have rendered themselves ineligible by moving out of state.
Today, let’s look at what the Medicaid unwinding process will look like specifically in Nevada, Arkansas, Mississippi, Kansas, New Mexico, Nebraska, and Idaho.
Nevada’s Careful Medicaid Unwinding Process Will Take 14 Months
Nevada intends to use all 14 months allotted to states by the federal government to complete the Medicaid unwinding process, the longest timeline option available to states at this time. Nevada’s unwinding process will begin on April 1st, 2023 and continue on until May 31, 2024. Renewal letters and redetermination decisions will be made on a rolling basis, based on the month in which members originally signed up for their plans. Renewal notices will be sent two months ahead of renewal dates, giving members time to respond to information update requests and update their contact information, as well.
Arkansas’ Medicaid Unwinding Process The Shortest of All
Arkansas is ruffling feathers with its Medicaid unwinding plan, which is set to bump 586,998 members off their current health insurance plan. Arkansas breakneck 6-month timeline is the shortest announced by any state of the union. While most other states have chosen a 12 month plan, and with 14 months being the longest option available, Arkansas’s need for speed is backed by Gov. Huckabee Sanders’ commitment to reduce what she sees as excessive “government dependency” in the state. It’s true that Arkansas has the highest Medicaid enrollment of any state - with well over 1 million members and almost 25% of the state’s total population enrolled in some form of Medicaid. However, some commentators have shared concerns that such a speedy redetermination process may erroneously mark members as ineligible, accidentally disqualifying those who should remain on the plan.
Medicaid Unwinding in Mississippi Likely to Boot Many Behavioral Health Patients
Although Mississippi has adopted a moderate 12-month timeline for its Medicaid unwinding process, there are concerns about what will happen to those members who are found ineligible for state health insurance in the coming months. These concerns stem mostly from the fact that Mississippi is one of ten states that has not yet adopted Medicaid expansion. This choice has created a “coverage gap” for Mississippi residents who might be too “wealthy” to qualify for the state’s stringent Medicaid income requirements while also being too “poor” to qualify federal Marketplace coverage subsidies. Couple this fact with allegations that Mississippi may have intentionally kept the existence of continuous enrollment during the pandemic hush-hush in an effort to keep enrollment rates artificially low and there’s ample reason for behavioral health patients and providers to be suspicious of the state’s Medicaid unwinding plan.
Medicaid Unwinding in Kansas Takes a Middle Path
Like Mississippi, Kansas has also not adopted or implemented Medicaid expansion. For information on how that exposes residents to a possible “coverage gap,” refer to the above section on Mississippi.
The 12 month Medicaid review and redetermination plan in Kansas will begin in April 2023. Kansas’ notification window is relatively short, with renewal notices - Kansas calls these “reviews” - arriving just 4 weeks before the due date. This leaves Kansas Medicaid recipients with very little time to respond to information requests and places a large importance on keeping contact information, especially address information, up-to-date with the state.
However, unlike some states, Kansas will default to a “passive review” for those member families who are found to be unlikely to have had a significant change in their eligibility. This means that not every family will need to respond to a letter from the state and complete the missing pieces in a “pre-populated review” form in order to retain their Medicaid coverage.
New Mexico May See 100,000 Medicaid Patients Lose Coverage During Unwinding
New Mexico has close to 1,000,000 residents currently enrolled in some form of Medicaid plan. Experts estimate that roughly 100,000 of those individuals will lose their coverage as continuous enrollment comes to a close and redeterminations weed out ineligible users. Although New Mexico’s Medicaid roster is small compared to other states with higher populations, the proportion of New Mexicans who carry Medicaid plans is the highest of any state, with more than one in three New Mexicans carrying some form of state-subsidized health insurance plan. Because New Mexico is a Medicaid expansion state, most members who are found ineligible during unwinding based on income requirements should still be able to qualify for federal ACA Marketplace coverage subsidies through the federal government.
Surviving Medicaid Unwinding in Nebraska Means Updating Contact Information Ahead of Time
Nebraskans will begin losing Medicaid coverage as continuous enrollment ends in the state and “normal operations” resume March 1st, 2023. Because redeterminations take roughly 1 month to process in Nebraska, April 2023 will mark the beginning of disenrollment for Medicaid members who are found to be ineligible for benefits. The state plans on completing the unwinding process within 12 months of beginning. It’s important to understand what to do if you or one of your patients loses coverage in Nebraska due to the unwinding process, but experts agree that the most important step Medicaid members in Nebraska can take is prevention. That’s why Nebraska is encouraging members to update their contact information on ACCESSNebraska well ahead of the redetermination process. This way, members can ensure that renewal notices can actually reach them in time to complete the renewal process.
Idaho Will Require All Members to Actively Renew During Medicaid Unwinding
Beginning April 1st, 2023, Idaho will commence its unwinding process and begin weeding out roughly 150,000 Medicaid enrollees who are no longer qualified for the program. The state plans on sending out 30,000 notices each month until all Medicaid enrollees have been notified of the change. IN Idaho, there will be no passive renewal option, meaning that every single individual who wishes to retain their Medicaid enrollment status will need to actively respond to the state’s renewal notices, regardless of their presumed eligibility status.
Because Idaho is one of the ten states that has not adopted or enacted Medicaid expansion, Idahoans who lose their coverage with the end of pandemic era continuous enrollment may struggle to make the financial leap from Medicaid coverage to an ACA Marketplace plan. This fact, coupled with the state’s insistence on active renewals, means that many Idahoans’ insurance status will likely soon be in jeopardy.
Other Blog Posts About Medicaid Unwinding at the State Level and How it May Affect Behavioral Health Organizations
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