About 500,000 in U.S. Will Regain Health Insurance After State Errors

Nearly half a million Americans, including children, will be able to keep their Medicaid and CHI coverage after state officials found major flaws in their eligibility review processes, federal officials said Thursday.

The pandemic-era program that guaranteed Medicaid coverage ended in April, and states began to check to see if tens of millions of people still qualified, taking people off the rolls if their income exceeded program limits or other criteria.

Most states used software that automatically checked eligibility, and used government databases to check income levels. However, 30 states, as confirmed by federal officials on Thursday, were vetting statuses incorrectly, resulting in hundreds of thousands of children losing coverage when their parents didn’t return forms to confirm that everyone in a household was eligible.

The Biden administration warned states last month, giving them a two-week window to report whether they were improperly disenrolling people. But the timing of the notice raises questions about why federal health officials and state counterparts failed to identify a fundamental flaw in the renewal process.

“This will help strengthen access to Medicaid not just during this very challenging renewal transition but also in the long term,” Chiquita Brooks-LaSure, the Medicare and Medicaid chief, said at a news conference on Thursday.

The unwinding of Medicaid enrollment has had catastrophic consequences for poor families and children across the country. More than seven million people have lost coverage through the program since the enrollment requirement ended in April, according to state data analyzed by KFF, a nonprofit health policy research group.

In states that have broken enrollment figures down by age, children account for nearly 1.4 million lost coverage. Children have higher eligibility limits for Medicaid enrollment, which means they have more leeway to stay on the rolls.

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At the Thursday briefing, Daniel Tsai, a Medicaid official, said that children are likely a “substantial number” of the nation’s nearly 500,000 remaining coverage holders. “We’re still looking at the data on who lost coverage improperly,” Tsai said. “The Biden administration ordered the states that found the errors to stop what’s known as a procedural disenrollment.” Procedural disenrollments occur when a beneficiary doesn’t confirm eligibility to a state Medicaid agency and then loses coverage.

Mr. Tsai added that some states were able to fix the issue quickly and would be able to resume eligibility checks soon, as long as they continued to have the fix in place and could ensure that no eligible people were disenrolled due to the issue. Others, he added, may take months to fix the issues and resume enrollment decisions, and some of those whose coverage is restored may still lose it.

In most of the 30 states on Thursday, the technical errors affected less than 10,000 individuals, according to the spreadsheet that federal officials provided to reporters. In Pennsylvania and Nevada, however, more than a hundred thousand people were affected in each state.

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In Nevada, a spokeswoman for the state’s department of health and human services, Kristen Muessle, said that about 114,000 people had their Medicaid coverage restored after state officials learned about the errors. She also said that procedural denials had been paused while Nevada worked on computer system enhancements.

The state figures published on Thursday were estimates, meaning that many more children may have been affected by the improper eligibility checks than are currently known. Some states that admitted to conducting the checks incorrectly are still assessing how many people were impacted, suggesting the total could be well over 500,000.

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