Utah’s high Medicaid enrollment rate might lead to redetermination backlog and lost coverage after pandemic

The Urban Institute recently released a study showing the increase in Medicaid enrollment growth rates in states across the country, due to “unprecedented” job loss and the Families First Coronavirus Response Act’s prohibition on disenrolling beneficiaries. 

The study found that Utah had the highest enrollment growth rate in the country in the last six months data was reported. Higher growth rates might lead redetermination backlog as the public health emergency (PHE) disenrollment prohibition ends, which is expected at the end of 2021. 

 

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The study — funded by the Robert Wood Johnson Foundation — said enrollment during the pandemic between Feb. 2020 and Jan. 2021 increased by over nine million people. By the end of 2021, it is estimated there will be 17 million more nonelderly people enrolled in Medicaid than before the pandemic started. 

Utah had the third highest growth rate in Q2 2020 — the three months directly after the pandemic’s start — and the highest growth rate in the county over the last six months reported. Below is a chart showing the growth rate of the last six months reported. 

 

Image: The Urban Institute

 

The chart shows that Utah has a 2.2% monthly enrollment increase, which is significantly higher than all other states. The study said this is because of how Utah timed their Medicaid expansion:

“Much of this is likely because of the way Utah phased in its Medicaid expansion; adults with incomes between 100 percent and 138 percent of the federal poverty level were able to enroll for the first time starting in January 2020. New enrollment caused by that change likely took months to fully materialize.”

However, when the PHE ends, prohibition on disenrolling Medicaid members ends, and many new members will lose their coverage. The study estimated about 15 million people — 8.7 million adults and 5.9 million children around the country —  could lose their coverage. 

The study said the Centers for Medicare and Medicaid Services (CMS) recently changed the rule to allow states twelve months to reinstate pre-PHE income eligibility rules instead of six. However, the study said the expected loss of the enhanced federal medical assistance percentage (FMAP) in March 2022 “gives states a financial incentive to process enrollment more quickly.”

According to the Kaiser Family Foundation, states will be expected to unwind emergency authorities around Medicaid and Medicare after the PHE. They said:

“Consequently, states will need to address a backlog of Medicaid eligibility renewals and redeterminations as well as continue to process new applications after the PHE ends.” 

According to the study, Utah could lose more than 200,000 enrollees in six months. Authors of the study said policymakers “have time before the PHE expires to consider how to best address both Medicaid beneficiaries’ needs for maintaining health coverage and the financial and administrative pressures on states and local governments.”

The study said roughly all those projected to lose Medicaid coverage have alternative health coverage eligibility options either through the Children’s Health Insurance Program (CHIP), the Marketplaces, or Employer-sponsored coverage.