Three months after the end of a pandemic policy that prevented states from kicking people off Medicaid, most Connecticut enrollees still qualify for coverage.
During the public health emergency, the federal government allowed people to stay on Medicaid, even if their income rose above the eligibility limits. On March 31, that measure came to an end, and the 12-month process of “unwinding” began. During unwinding, the state is reassessing eligibility for broad swaths of Medicaid enrollees for the first time in three years.
Nearly 75% of the roughly 274,000 residents who went through unwinding in April, May and June kept their Medicaid coverage, according to data submitted by the Department of Social Services to the Centers for Medicare and Medicaid Services.
The rate could change slightly as the state has a window to resubmit the data to CMS, according to a DSS spokesperson.
Earlier this year, DSS projected that, during unwinding, the number of applications for Medicaid would increase by 70% over the previous year. At the time, legislators and health care workers worried that state agencies would have trouble keeping up with the sheer number of applications, leading to widespread gaps in coverage.
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“It was something that we were concerned about but we were working proactively to address, and, so far, that's looking pretty good,” said Peter Hadler, the deputy commissioner at DSS.
As of May, the state had a lower disenrollment rate than the national average, meaning that Connecticut residents are more likely to re-qualify for coverage than people in the other states.
"Commissioner Barton Reeves and her team have done quite well given a tough hand," said Sen. Matt Lesser, D-Middletown.
Still, over 62,000 people have lost Medicaid since unwinding began.
Around 10,000 people lost coverage because they were no longer eligible, representing just 4% of total renewals. Approximately 52,000 people — 19% of renewals — lost coverage because they did not update their personal information as the application process requires.
Hadler said that, in April, based on the data DSS did have access to, roughly two-thirds of those who didn't update their information would no longer qualify. This group would include, for example, people who qualified for Medicaid because they lost their jobs early in the pandemic but who have since found employment that puts them over the income limit.
“We want to give everyone a chance to enroll even though our expectation is many won’t be eligible based on IRS data,” he said.
The unwinding queue functions on a "first-in, first-out" basis, meaning the people being reassessed for eligibility early in the process are those who have had the most time lapse since their last renewal. That also means they're more likely to have experienced a change in circumstance, like a new job or an increase in income, said Hadler.
Lesser said he'd like to see the state push to explore more ways to ensure people find other forms of coverage, including by studying solutions used by other states.
"I'm not willing to say, 'Hey, we've done enough,'" he said.
How does unwinding work?
Sixty days prior to a person’s renewal date, the state will attempt a “passive renewal,” a process by which DSS can automatically renew Medicaid coverage using data from the CT Department of Labor and the IRS. If this is successful, the recipient will receive a notice that their coverage has been renewed and that no additional action is required.
In the first three months of unwinding, just over half of renewals were passive. Hadler said he hopes DSS can find ways to push that rate higher.
If the state cannot passively renew the coverage, the person will receive a pre-populated renewal application in the mail 45 days prior to their renewal date, which they will have to complete either online, by phone or on paper.
What's available for those who no longer qualify for Medicaid?
Hadler also emphasized that people should update their information, even if they think their income disqualifies them from Medicaid.
“They may think that there are no options for them, but we've really encouraged them to come back in and find out for sure. And especially if they've got children in the household, because the children can stay on different types of free coverage, up to much higher income levels,” said Hadler.
People on HUSKY A — which covers qualifying children and their caretakers — who no longer qualify based on income could potentially qualify for another year of HUSKY coverage through a program called Transitional Medical Assistance, or TMA. Others who surpass the HUSKY income limits but still fall below 175% of the Federal Poverty Level, or FPL, qualify for a no cost plan through Covered CT.
“It’s for a silver plan offered through Access Health CT with HUSKY-provided wrap-around for dental and non-emergency medical transport,” said Hadler. “And there are no costs. It’s a very good plan.”
Those who don’t qualify for either TMA or Covered CT can also purchase low-cost coverage through a qualified health plan on Access Health CT. The Lamont administration earmarked $10 million in ARPA funding to pay for two months of premiums for individuals with incomes between 175 and 200% of FPL who enroll in an Access Health CT silver plan.
Lesser said he wishes expanding eligibility, both for Medicaid and Covered CT, had been a focus of the budget passed by the legislature in June.
"We found a lot of money for a lot of things, but this was a population that was left in the lurch," he said. "I can't help but feel that it's a missed opportunity to really do more to support people who are really in need of health care."