While health agencies have been working nonstop to help Washingtonians maintain their insurance coverage since Medicaid redeterminations began, their leaders continue to focus on new strategies to prevent more residents from losing coverage.
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. Washington began its process in April, and has seen about 390,000 individuals lose coverage.
Those involved with redeterminations discussed the process at the Inland Northwest State of Reform Health Policy Conference last week.
“We started this process with a 5.3 percent uninsured rate in 2021, which was the best uninsured rate we’ve had in our recorded history,” Northwest Health Law Advocates Deputy Director Emily Brice said. “We’ve now had about 390,000 people terminated. That’s losing about 15 percent of the total Apple Health (Medicaid) population in just a few months. And that is obviously a significant change for our state to go through.”
There is an expectation that the state could potentially end up disenrolling 560,000 Medicaid enrollees, Brice said.
“That’s about a quarter of our Apple Health population. We think about this as the biggest event in health coverage since the Affordable Care Act. Some of those folks will have other coverage sources and some will not.”
— Brice
Rebecca Carrell, deputy director of Medicaid programs at the Washington State Health Care Authority (HCA), said the HCA has been sending renewal notifications every month since March.
“March had the highest number of renewal notices sent out,” Carrell said. “A lot of individuals lost Medicaid because they’re no longer eligible for Medicaid. So a lot of the work we’ve been doing is (centered) around, how do we get them connected to a QHP (qualified health plan)? Or how do we get them reconnected?”
Carrell said about 51,000 individuals lost coverage in August, which was down by about 50 percent from the approximate 111,000 individuals the agency has seen lose coverage in each of the past three months, on average.
The top reason individuals are being terminated is because they are not responding to renewal notices, Carrell said, followed closely by non-financial eligibility reasons. The third most prominent reason for loss of coverage was financial eligibility, Carrell said.
Brice noted a relatively high percentage of procedural terminations.
“Some of those people aren’t returning paperwork because they have other coverage and don’t need it anymore. But we know some of those people are disconnected for other reasons. They have unstable housing, or they have moved and are not connected to the system. So I think we need to be concerned about that high rate of procedural terminations.”
— Brice
Carrell said the HCA’s outreach efforts have centered on ensuring individuals are aware that they’re up for renewal. The agency is using new options like phone calls and text messages to reach clients.
“And they’ve been really well-received,” Carrell said. “We’ve gotten some really good feedback.”
The HCA has also been using the new Apple Health Ambassador program, which utilizes volunteers to help people understand the actions that need to be taken to maintain coverage, including updating contact information and responding to renewal notices.
“It’s something that we came up with during the unwind,” Carrell said. “These are individuals who are working in the community or at schools; all sorts of individuals from across the state who are in touch with Medicaid individuals who are providing toolkit information, flyers, (and) information on how to get someone connected to help if they have questions as they’re going through their renewals.”
Community Health Plan of Washington CEO Leanne Berge highlighted the importance of the organization’s partnering providers, particularly community health centers (CHCs), during the redetermination process.
“They have the most up-to-date contacts and connections with members. CHCs provide care for more than one million Medicaid members. So they’re the backbone of our system for Medicaid. The CHCs are very engaged because this is their work.
By having real transparency on who is receiving termination notices, and being able to share that with our provider community, we’ve been able to avoid terminations by reaching people that would not otherwise be reached. So we see a lower percentage of people lose coverage than otherwise would be the case.”
— Berge
Joan Altman, director of government affairs and strategic partnerships at the Washington Health Benefit Exchange, said a key metric the exchange studies is whether residents attempt to determine if they are eligible for a QHP after they exit Apple Health.
“Typically, we only see less than 20 percent of them actually sign up [for a QHP],” Altman said. “So with the subsidies and outreach, and all the work that’s happening, we’re seeing massive increased traffic at our Healthplanfinder and call center. The good news is a 61 percent increase in our web traffic. In terms of helping people get from point A to point B, we’re seeing a 65 percent increase in our conversion rate for people who are signing up for a QHP. That is a massive increase in a short amount of time.”