Medicaid redeterminations: Washington’s disenrollment rate much lower than many states


Shane Ersland


Washington has seen about four percent of its Medicaid enrollees lose coverage since redeterminations began in April, which is a much lower rate than many reporting states.

Trinity Wilson, assistant director for Medicaid customer service at the Washington State Health Care Authority (HCA), updated lawmakers on the state’s redetermination process during a Senate Health and Long Term Care Committee meeting on Wednesday.


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The federal requirement for continuous coverage for Medicaid recipients ended on March 31st, and the Centers for Medicare and Medicaid Services recommended that states begin their unwinding processes in February, March, or April. 

“Our state chose to begin unwinding in April, which was in alignment with 29 other states,” Wilson said. “We’ve also opted to leverage the full 12 months available to us to re-determine eligibility for all Medicaid recipients during this unwind period.”

More than 2.3 million Washingtonians were Apple Health (Medicaid) clients in May. About 235,000 customers were due for a renewal by May 31st, Wilson said.

“What we saw as a result of those renewals was approximately 116,000 of those customers lose Medicaid effective June 1st,” she said. “Another 245,000 were due for a renewal by June 30th. As of July 1st, we did see another 114,000 (lose) coverage as a result of those June renewals.”

About 69 percent of those who lost coverage in May were disenrolled due to a failure to respond to the HCA’s requests to renew coverage, Wilson said. Some Medicaid enrollees were eligible for a 90-day reconsideration period, however.

“The good news is that due to extensive outreach and the 90-day reconsideration period, we have seen many individuals come back on to the program as of June. So we are seeing a net loss of four percent of the total Medicaid population, after we’ve seen some individuals that have re-enrolled into the program during the reconsideration period, and some new applications for the Medicaid program.”

— Wilson

The four percent loss represents 88,373 enrollees between May and June, and includes clients who enrolled in May. There is a wide variation in disenrollment rates across reporting states, with the highest rate represented by Texas at 82 percent, according to Kaiser Family Foundation. Idaho has the second highest rate at 76 percent, followed by South Carolina’s 72 percent rate and Kansas’ 65 percent rate.

“It’s going to take us a few months to fully capture the number of recipients who are re-enrolled to the program as a result of that 90-day reconsideration period,” Wilson said. “But we do expect the total volume of renewals, as well as the percentage of terminations, to begin to decrease in August and all the way through the end of the unwind.”

The HCA expects the highest volume of renewals, and subsequently the greatest loss in Medicaid coverage, within the first three months of the unwind, Wilson said. 

“The reason for that is because for the last three years we have been attempting to renew coverage for all Medicaid recipients annually. For those we have not been able to contact, and have not engaged with us, we have been extending their renewal dates every 90 days.”

— Wilson

The HCA has utilized several outreach methods to raise awareness, Wilson said, including mailing and emailing renewal notices, initiating outreach calls to recipients, and engaging with managed care organizations that have attempted to renew coverage for their members. 

“We also initiated a volunteer ambassador program,” she said. “We have recruited approximately 300 volunteers from communities across the state in order to raise awareness and share with our customers that they may need to take action to maintain coverage.”

Individuals whose renewal resulted in a loss of coverage have other coverage options, including through the state-based exchange, through Medicare by way of special enrollment period, or through employer-sponsored insurance, Wilson said. 

“Our primary goal throughout this unwind period is to assist our Medicaid recipients in processing their renewals, and to make transitions to other coverage as smooth as possible when necessary,” she said. 

Joan Altman, director of government affairs and strategic partnerships at the Washington Health Benefit Exchange, also gave an update during the meeting, and said the exchange has seen an uptick in activity as residents look to its Washington Healthplanfinder for alternative coverage options. She said the exchange’s customer support center has seen a 42 percent increase in Medicaid-related call volume.

“In June alone, we got 62,000 calls. Washington Healthplanfinder web traffic is up 64 percent compared to this time last year. Almost 20 percent of those who lost Apple Health since April 1st have already regained coverage through Washington Healthplanfinder. That’s a pretty good chunk of people who have come off, so far, who are coming back in and getting continuous coverage. The people we’re seeing come back in are more likely to be younger, and they’re more likely to be people of color.”

— Altman

Yakima Neighborhood Health Services (YNHS) CEO Rhonda Hauff said the organization has enrolled nearly 220,000 residents through Washington Healthplanfinder since October 2013, and 95 percent of them were on Apple Health. She said 2,000 customers were up for renewal in  May and June, while 1,359 were able to renew and 607 were terminated.

“The majority of the terminations were deemed as incomplete,” Hauff said. “Our understanding is the [reasons for incompletion] ranged from they didn’t complete their review, which was our greatest fear, to incomplete asset verifications.”