Enrollees largely unaware of Medicaid redetermination process

A full two-thirds of enrollees aren't sure if states can now remove people from Medicaid if they no longer meet eligibility.

By Jeff Lagasse, Associate Editor / May 25, 2023

States kept people continuously enrolled in Medicaid during the COVID-19 pandemic in exchange for enhanced federal funding, but continuous enrollment ended on March 31, and over the coming months states will redetermine eligibility for enrollees and disenroll those who are no longer eligible. And according to a new survey, most Medicaid enrollees are unaware of this process.

The new KFF survey released Wednesday shows about two-thirds (65%) of all Medicaid enrollees say they are "not sure" if states are now allowed to remove people from Medicaid if they no longer meet the eligibility requirements or don't complete the renewal process, with an additional 7% incorrectly saying states will not be allowed to do this.

Three in four adults 65 and older say they're unsure if states are allowed to remove people from Medicaid, and Black adults are more likely than white adults to incorrectly say that states will not be allowed to do this. Just under three in ten (28%) overall are aware states are now allowed to remove people from Medicaid.

Part of the confusion may stem from the fact that almost half of enrollees said they've never been through the Medicaid renewal process before. That includes two-thirds (68%) of Medicaid enrollees who are 65 and older and more than half of Medicaid enrollees who are between the ages of 18 and 29 (53%).

WHAT'S THE IMPACT?

Other results from the survey show additional confusion around the process, even when it comes to updating their contact information with their state Medicaid agency – something one-third of enrollees said they haven't done in the past year.

Older adults are more likely than younger age groups to say they have not provided updated contact information to their state, with about half (48%) of those 65 and older saying they have not done this, though older adults' contact information may be more stable and thus less likely to require updating.

Overall, one in five Medicaid enrollees haven't participated in a renewal process before or updated their contact information; the share increases to 39% when looking at those 65 and older.

About half of Medicaid enrollees prefer to receive renewal information through modes other than the U.S. mail, which is still the primary method of communicating with enrollees by most state Medicaid agencies. This allows a potential avenue for state agencies to reach more people, as providing renewal information through multiple methods – including email or an online portal, for instance – can increase the chance that people receive the information, the survey found.

About three in 10 (29%) say they prefer to receive information via email, and about one in 10 say they prefer to get information through an online portal (11%) or via text message (8%). Three-quarters of older adults say they prefer to receive renewal information through the mail, but younger adults are equally likely to prefer receiving information through the U.S. mail (39%) as through email (37%).

Most enrollees said their financial and life circumstances have not changed, suggesting they're still eligible, but about one-third said they've had a change in income, or some other change, that could make them ineligible, or are unsure if they've had such a change. Importantly, many may not have had a significant change, but could still be disenrolled if they're unable to complete the renewal process.

While about six in 10 of those with Medicaid as their only source of coverage would look for coverage from other sources if they were told they were no longer eligible, over four in 10 say they wouldn't know where to look for other coverage or would be uninsured.

The large majority of Medicaid enrollees say having an expert help with the renewal process would be useful. Only about one in six either say it would be "not too useful" (11%) or "not at all useful" (3%).

THE LARGER TREND

Up to 18 million people are projected to lose Medicaid coverage as the continuous enrollment requirement put in place under the public health emergency ends. The Families First Coronavirus Response Act prevented state Medicaid agencies from disenrolling people during the PHE.

The omnibus spending package that passed at the end of 2022 gave states a heads up on Medicaid coverage. Under the bill, states were able to begin processing Medicaid redeterminations on April 1.

At the tail end of April, Republicans in the House of Representatives passed a debt ceiling bill that includes a stipulation for states to implement work requirements for certain Medicaid enrollees. A KFF analysis determined that if the work requirement was fully implemented in 2024 and the rate of Medicaid eligibility loss was as the Congressional Budget Office estimated, then 1.7 million enrollees would not meet work or reporting requirements and potentially face disenrollment.