Medicaid commissioner tells lawmakers West Virginia is working diligently through unwinding

By Brad McElhinny / September 12, 2023

West Virginia’s Medicaid commissioner tried to reassure lawmakers about the thousands of state residents being ruled ineligible for government health insurance programs.

“We want everyone who is eligible for Medicaid to remain on Medicaid,” said Cindy Beane, commissioner of the state Bureau of Medical Services during testimony before the Legislative Oversight Commission on Health and Human Resources Accountability.

But, she said, recent circumstances have been complicated.

Many of those have been ruled ineligible not because they wouldn’t qualify, but instead because they haven’t completed their paperwork.

During the most recent reporting period, 18,796 people who previously qualified for government health insurance were removed from the rolls for procedural reasons. That included 7,624 children.

The number of children among the unenrolled has been of particular concern, and Beane said West Virginia is taking a special look at those circumstances. In many cases, those children are eligible to be covered under other forms of insurance, she said.

Federal officials raised concern last month that in West Virginia 24 percent of the 47,329 people up for renewal of CHIP or Medicaid were removed for a procedural reason.

“This high percent raises concerns that eligible individuals, including children, may be losing coverage,” wrote Anne Costello, deputy director of the federal Centers for Medicare and Medicaid. “Federal regulations … require the agency to continue to provide Medicaid to eligible individuals until they are found to be ineligible.”

Beane today described relationships with federal counterparts as unusually contentious.

“There are new interpretations of the rules at the federal level that states have not anticipated,” Beane said, elaborating to describe a change in how federal officials want to process automated renewals where state officials assess financial information already at hand. She described it as “a non-touch” because the person doesn’t have to actively apply.

“CMS is looking at everything differently with regards to the unwind.”

This entire situation is happening as states snap back to Medicaid eligibility requirements that were in place before the covid-19 pandemic. Medicaid is the joint federal and state program for some low-income people, families and children, pregnant people, the elderly and people with disabilities.

During the pandemic there was a requirement that Medicaid programs keep people “continuously enrolled.” Now the regular enrollment requirements are returning back into effect in states across the country, a process described as “unwinding.” Estimates indicate 8 million to 24 million will be removed from the rolls across the country.

Since the start of the pandemic, West Virginia Medicaid increased by 160,250 enrollees. The numbers rose from 504,760 in March 2020 to 665,010 in March 2023 because of the sustained enrollment provision during the pandemic.

“For three years nobody went off Medicaid, meaning that for three years our rolls went up exponentially,” Beane said.

That continuous enrollment condition came to an end on March 31. States started resuming normal operations, including restarting full eligibility renewals for Medicaid and the Children’s Health Insurance Program and terminations of coverage for people who are no longer eligible.

“We have advertised the importance of getting your Medicaid renewal completed so much that we had people coming into the Medicaid office before it was even time for the renewal, which was a new phenomenon for us,” Beane said.

Even now, as the unwinding continues, Beane described time and opportunities for people to enroll.

“Medicaid is not like your typical private insurance. You can come onto Medicaid at any time,” she said.

“So if for some reason, even though we’re doing two calls, text message, letters, all these things to make sure you realize it’s important, if for some reason all of that — you didn’t answer your phone, you didn’t respond to the letter, all of that — and then you show up at the hospital you can still get Medicaid services.”