Medicaid unwinding draws scrutiny from state lawmakers

Nevada legislators are expressing frustration over the state’s inability to track people who were wrongfully disenrolled from Medicaid last year.

“People are transient, and they list an address but it’s not exactly where they live, and we as government officials will send out government notices saying ‘hey you need to fill out this form’ but they might not even receive it,” state Sen. Fabian Doñate, chair of the Interim Committee on Health and Human Services, during a meeting last week.

Nevada had one of the nation’s highest Medicaid disenrollment rates due to procedural causes like missing paperwork during the process of unwinding a federal policy designed to keep people covered under Medicaid during the pandemic. As a result, 114,000 Nevadans lost their health care coverage, only to have it reinstated months after the Centers for Medicare & Medicaid Services (CMS) intervention.  

Lawmakers on the interim committee sought explanations from the Division of Welfare and Supportive Services (DWSS) about how the state tracks people who may still qualify for Medicaid, but who haven’t been re-enrolled.

Vulnerable populations who are often eligible for Medicaid may be experiencing homelessness, facing language barriers, lacking access to transportation, or dealing with other conditions that prevent them from filling out the re-enrollment packet mailed to them, returning it, or even receiving it in the first place, said Republican state Sen. Robin Titus.

“I’ve been at this in the past and just the accessibility of getting those applications returned. A lot of folks on Medicaid may not have a home, may not be able to get to the post office, and may not be able to return those,” Titus said. 

Despite the ongoing concerns that procedural terminations still disproportionately impact marginalized and at-risk populations that have plagued the unwinding process, there is no data on what’s happening to those who have to fill out the packets but don’t. 

“Are there metrics that our state has gathered post unwinding to make sure that those folks [aren’t disenrolled] as a mistake?” asked Doñate, who chairs the committee.

“We are not currently gathering or surveying members as to why they’re falling off the rolls,” said Sandie Ruybalid, deputy administrator of the Nevada Department of Health and Human Services Division of Health Care Financing and Policy. 

“Some states are doing that, but we don’t have the resources at this time to perform that kind of outreach,” Ruybalid said.

At the start of the unwinding process, 80% of Nevadans enrolled in Medicaid were disenrolled from Medicaid because of procedural causes, one of the highest in the nation. Most of them were renewed automatically through a new system. 

About 12% of those have been terminated, said Kelly Cantrelle, the deputy administrator for DWSS, at the meeting. State date indicates in the last 12 months, 22,914 Nevadans have been disenrolled from Medicaid and not reinstated.

CMS paused disenrollment for procedural causes after it found that Nevada and most other states had “state systems issue” that led to “inappropriately disenrolling children and other enrollees, even when the state had information indicating the person remained eligible.” 

Older adults, people who have moved, immigrants, people with disabilities, and people with limited English proficiency are at an increased risk of losing Medicaid coverage or experiencing a gap in coverage due to barriers to completing the enrollment process, according to a KFF brief.

Procedural disenrollments resumed in January, and Nevada’s unwinding process is estimated to end in September,  Cantrelle told the committee.