CMS rolls out new flexibilities that aim to avert procedural coverage losses in Medicaid

By Paige Minemyer / June 13, 2023

The Biden administration is rolling out new flexibilities that aim to prevent procedural coverage losses as states work through a backlog of Medicaid eligibility determinations.

The Department of Health and Human Services announced that managed care plans can take on a more direct role in assisting members in completing renewal forms. This extends to filling out certain parts of the paperwork on behalf of the member.

In addition, states are able to delay administrative disenrollments by a month for further outreach, which will allow for greater time to fill out necessary forms and paperwork. The agency will also allow pharmacies and community-based organizations to assist in getting coverage reinstated for people who are still eligible but lost coverage for procedural reasons.

Procedural disenrollment is a key concern during the Medicaid redetermination period, as many people who are at risk of losing coverage are not aware that the process is even going on. A recent analysis from KFF looking at early redetermination data found that in a number of states, large numbers of disenrollments are linked to administrative issues.

In Indiana and West Virginia, for example, 89% of disenrollments so far are linked to procedural issues. Daniel Tsai, the deputy administrator and director of the Center for Medicaid and CHIP services at the Centers for Medicare & Medicaid Services (CMS), said this trend is "particularly concerning" for regulators.

He said the agency has conducted multiple focus groups that make it clear many eligible individuals and families are not informed about the redetermination process.

"We are urging and asking states to do everything in their power to keep eligible people covered," he said on a call with reporters Tuesday. "It’s not enough to follow the minimum federal requirements."

In addition to the new flexibilities made available this week. CMS has offered a number of waivers to states that can make the redetermination process easier. Tsai said on the call that every state except for two—Florida and Montana—have elected to utilize at least one of these waivers.

Tsai added that CMS is prepared to use all of its oversight and regulatory power to ensure states are doing as much as they can to avoid coverage lapses for people who are eligible for Medicaid. He said the agency is "aggressively monitoring" states for compliance and tracking data on disenrollment.

"That is our call to action to the broader community," he said.