Utah Medicaid redeterminations see a high number of procedural disenrollments


Maddie McCarthy


Of the 132,300 people who have been disenrolled from Medicaid in Utah during the state’s redetermination process to determine member eligibility for the program over the past few months, 94% were disenrolled due to procedural reasons.

According to KFF’s Medicaid unwinding tracker, Utah has the second highest procedural disenrollment rate in the country, behind New Mexico. Procedural disenrollments can occur because a beneficiary doesn’t respond to renewal notifications, paperwork processing is slow, individuals misunderstand the renewal process, and other other reasons.

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Of the completed redeterminations, 58% have been disenrollments and 42% (95,600) have been renewals.

The Utah Department of Health and Human Services (DHHS) sent a statement to State of Reform describing four areas the agency has focused on to address possible issues during the unwinding of Medicaid eligibility: communication, partnership, systems and processes, and policy.

DHHS said it has been promoting awareness of Medicaid redeterminations and the end of continuous enrollment since December 2021 as part of its regular communication to Medicaid recipients so they don’t miss their renewal opportunity.

“The state has developed and purchased billboard ads, transit ads, radio and TV ads, social media ads, toolkits for community partners and providers, electronic correspondence and reminders, a website with resources, customer service scripts, FAQs and flyers in 13 languages, interviews on radio and tv news segments, direct mail, news releases, virtual town hall meetings, and more.”

— Utah DHHS statement, Dec. 1st, 2023

DHHS is utilizing partnerships to make the process easier. The agency has collaborated with community partners, advocates, and providers to help people keep their coverage or find affordable insurance coverage if they have been disenrolled. 

“Recently, DHHS entered into a contract with a statewide nonprofit, the Utah Health Policy Project (UHPP), to expand enrollment assistance and healthcare navigation for individuals and families,” DHHS said. “These services are targeted to at-risk communities through innovative approaches that are specifically designed to address Medicaid unwinding.”

Matt Slonaker, executive director of UHPP, and Daryl Herrschaft, director of Take Care Utah (TCU), sent written statements to State of Reform discussing their collaboration with DHHS.

“Utah Health Policy Project is glad to be working more closely with the state Medicaid program to reduce procedural terminations in the state due to Medicaid unwinding,” Slonaker said. 

In his statement, Slonaker discussed TCU’s health access assisters (HAAs). UHPP’s TCU assists Utahans in their search for affordable healthcare. HAAs provide support and health coverage education to those that need it, and offer their services in multiple languages. 

“More needs to be done to connect with Medicaid members and link them to coverage options,” Slonaker said. “The [HAA] workforce is critical in providing that needed support in navigating the complicated health insurance enrollment process.”

Herrschaft discussed direct actions UHPP and TCU are taking to work with DHHS and support Utahans through their redeterminations.

“We will be training community health workers and medical office staff to help patients find their Medicaid status and direct them to trusted resources, and we are extending our office hours to make more appointments available … We will also be doing direct community education. The plan includes conducting in-person outreach events at high-traffic locations such as the [Department of Motor Vehicles], public transit stations, auto inspection stations, and laundromats.” 

— Herrschaft

DHHS has also worked in collaboration with the Utah Department of Workforce Services (DWS)—which is conducting the redetermination process—to help beneficiaries navigate the systems used for renewal, and to speed up the process. DHHS said its first priority is to try to renew who they can through ex parte renewals.

“Ex parte is the renewal process used by DWS to recertify eligibility without the customer submitting any information,” DHHS said. “… Automation has resulted in a significant reduction in the administrative burden on both the member and the DWS worker.”

KFF research shows that 55 % of Utah’s renewals so far have been completed through the ex parte process.

MyCase is the platform Utah uses for benefits applications. DHHS said they have made improvements to the applications for both new benefits and renewal of benefits so the time spent on the site is shorter than it was last year. The annual recertification application takes about 24 minutes to complete, and a new application takes about 29 minutes to complete, which is down 34% from the previous average, the agency said.

There are two reasons the customer service line has also improved, DHHS said. More staff are available to take calls on the customer service line due to the ex parte process. 

Furthermore, “DWS has also created short video aides to help individuals navigate [MyCase], reducing the reliance on phone calls to answer customer questions,” DHHS said. 

Combined, these actions have decreased wait times for customers calling about their Medicaid benefits. Customers waiting do not have to stay on the phone, but are instead placed in a queue to get a call back. The average wait time in May was 40 minutes, and it decreased to 21 minutes by October.

In terms of policy, DHHS said two aspects of future redeterminations will change on Jan. 1st, 2024. Children on Medicaid will be eligible for 12 months of continuous coverage even if their family’s income changes throughout the year, and postpartum women on Medicaid will also be able to have 12 months of continuous coverage through one year after the end of their pregnancy.

During the ongoing redeterminations, “Utah took temporary policy flexibilities to ensure more individuals may be renewed ex parte, including flexibilities to renew individuals with no income and no assets,” DHHS said. “Utah also took the temporary flexibility to allow managed care plans to assist members with renewals.”

Utah’s redetermination process is nearly complete, as it aims to redetermine the remaining 7% of its members by April 2024.