Medicaid Unwinding and State Behavioral Health in Montana, Minnesota, New York, Arizona, Colorado, Tennessee, and Washington

Nearly 40% of Medicaid enrollees meet diagnostic criteria for a mental or behavioral health condition. As federal requirements to retain all Medicaid enrollees during the pandemic begin to fade or “unwind,” it’s the states themselves that have control over the fate of millions of Medicaid enrollments. 

Let’s look at how these changes are playing out in 7 key states: Montana, Minnesota, New York, Arizona, Colorado, Tennessee, and Washington. 

Montana: State Medicaid Updates During the Unwinding of Continuous Enrollment

Medicaid enrollment in Montana flourished during the pandemic and the continuous enrollment period. 

Historically, Montana has a bad track record for Medicaid accessibility. The state denies more applications than most, so it’s expected that the unwinding process in Montana will result in many uninsured residents. States have 12-14 months to complete the “unwinding” process, but Montana has decided on a 10 - 12 month “unwinding” or reprocessing of Medicaid eligibility. 

Montana’s Department of Public Health and Human Services began checking for Medicaid eligibility in April 2023. 

Minnesota State: Unwinding Updates for the Phase-Down of Continuous Enrollment

Minnesota released its “Plan to Unwind Continuous Eligibility Coverage” in February 2023. It outlines the history of pandemic-era changes as well as effects on enrollment and then goes on to name challenges to name “renewal challenges” like budgetary constraints, workforce problems and other barriers to state-provided health coverage. 

The plan provides useful details for those anticipating possible changes to their enrollment eligibility. Eligibility will be reprocessed according to the month in which enrollee’s initially applied. They will begin with those who first enrolled in the month of July. Those enrollees will see a determination made beginning sometime in March 2023. MinnesotaCare renewals are slated for quarter 4 of fiscal year 2023.

New York State: A Three Phase Medicaid Unwinding Plan

New York state has created a toolkit to help New Yorkers understand the unwinding process and navigate health care in the post-COVID world. 

New York’s unwinding plan is a three phase one: first, they’ll spread awareness of important coming changes to Medicaid. Second, they’ll help every enrollee update their contact information with the state so that they can communicate renewal information effectively with individual enrollees. Third, they’ll help New Yorkers through the redetermination process and/or help former enrollees migrate to more appropriate coverage.

Arizona: 600,000 Medicaid Patients At Risk of Losing Coverage During Unwinding

Arizona began the Medicaid unwinding process in April 2023. 

Arizona Health Care Cost Containment System AHCCCS maintains a dashboard containing all the states’ information on this post-COVID change. According to a useful factsheet for Medicaid unwinding in Arizona, more than 600,000 members are at risk of losing their Medicaid and/or KidsCare coverage in the state, due to redetermination criteria and invalid personal contact information.

Colorado: About 80% of Members Should Remain After Medicaid Unwinding

Colorado’s Medicaid program swelled by up to 500,000 new members during the pandemic but it is slated to shed quite a few of those new additions soon. 

The state has gone on record saying that it believes that roughly 80% of current Medicaid enrollees will remain after the great disenrollment program is complete. That said, “hundreds of thousands” of enrollees could lose their Medicaid coverage - whether that’s Health First Colorado, or CHP+, the Child Health Plan Plus - during the unwinding process as it’s slated in Colorado. 

Tennessee: Medicaid Unwinding Likely to be Catastrophic for Many in This Non-Expansion State 

Along with Wyoming, Texas, Kansas, Wisconsin, Mississippi, Alabama, Georgia, Florida, and South Carolina, Tennessee is one of the 10 states in the union that has not adopted the ACA Medicaid expansion. That means that enrollees in this state are vulnerable to a “coverage gap” where poverty-level residents may not be “poor enough” to qualify for the state’s ultra-low Medicaid income requirements but “too poor” to qualify for ACA marketplace coverage subsidies. This is a policy issue where the state is essentially signaling they believe the federal government should cover these individuals, while the federal government is signaling the opposite - that the state should pick up the bill.

This makes Tennessee’s Medicaid unwinding plan to be a highly disruptive one for many vulnerable people in Tennessee.  

Washington State: Medicaid Unwinding Likely to be Less Brutal in This Medicaid Expansion Early Adopter

Washington state, like most other states, saw a huge growth in the number of Medicaid enrollees during the pandemic, in part due to Medicaid expansion. The state was an early adopter of Medicaid expansion in 2014. Currently, Apple Health (Washington’s name for its Medicaid program) ensures well over 2 million people. Those individuals with incomes that have shifted below 138% of the federal poverty level will soon lose their coverage due to the Medicaid unwinding process now underway in the state. 

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