More than 66,000 Idahoans who had pandemic-era protections are losing Medicaid

Tens of thousands of people aren’t responding, after three years of automatic Medicaid coverage

By Audrey Dutton Idaho Capital Sun

More than 66,000 people are set to lose Idaho Medicaid coverage, as the state undertakes a major review of eligibility following the end of the national public health emergency during the COVID-19 pandemic.

That’s about 73% of the people whose Medicaid reviews Idaho has completed so far. The state has about 62,500 more reviews to complete. If the trend continues, more than 100,000 people who had Idaho Medicaid this spring would lose health coverage — unless they get private health insurance, try to re-enroll in Medicaid or obtain coverage some other way.

To lose Medicaid, those Idahoans either didn’t submit paperwork to prove their eligibility, or the state reviewed their cases and found they didn’t meet criteria.

Tens of thousands who are losing health coverage were deemed ineligible after not responding to renewal notices.

State health officials knew at the start of the review that low-income Idahoans could lose Medicaid coverage — even though they still qualify — because they didn’t receive, read, understand or respond in time to notifications.

The department this week added as “ineligible” the Idahoans who never responded to notices to reapply for Medicaid — a group that numbers in the tens of thousands, based on a comparison of the data published June 5 and previous tallies.

Last week, the state reported having reviewed the eligibility of 58,743 people on Idaho Medicaid. It determined that about 23,500 of those people could stay on Medicaid and about 35,200 could not, according to the Idaho Department of Health and Welfare’s weekly data.

The count June 5 showed 91,350 reviews processed, with 25,070 Idahoans are eligible and — now including those who didn’t respond to notifications — 66,280 are ineligible to stay on Idaho Medicaid.

Idaho Medicaid is a state-run but mostly federally funded program that pays for health care for low-income Idahoans of all ages.

During the COVID-19 public health emergency, Medicaid cover- age was largely frozen in place — as officials sought to ensure people could seek health care. As the U.S. neared the end of the emergency this year, Medicaid officials across the country prepared to start reviewing whether people with pandemic-era uninterrupted Medicaid coverage are actually still eligible for it.

Idaho planned to notify about 20,000 Medicaid households each month that it was time to reapply for coverage — from early 2023 through this fall.

Risk of losing Idaho Medicaid in error

The U.S. Department of Health and Human Services estimated that more than 17.4% of Americans would be removed from Medicaid as states undertook these reviews.

But the department estimated that only about half of those dropped from Medicaid would lose coverage because they were no longer eligible — having moved to another state or gotten a higher paying job, for example. The rest — about 8% of the people on Medicaid — would lose coverage “despite still being eligible,” according to the department’s estimates.

That means several thousand Idahoans could lose Medicaid coverage when they still qualify for it — after missing a deadline to fill out paperwork or not seeing a notice from the state, for example.

The Idaho Department of Health and Welfare anticipated this.

“We recognize that during the [COVID-19 emergency], there has been minimal or no contact with many participants for an extended period, as many have not completed a renewal for their Medicaid coverage,” the department said in its plan for the mass Medicaid review.

“Because of this, there is a significant risk participants who would otherwise be eligible may lose their Medicaid coverage [because] they have a new address or they have not updated other contact information since their last renewal” which, for most people, was more than three years ago.

The department’s strategy to make sure low-income eligible Idahoans don’t lose health coverage included creating “a dedicated unit to process contact information changes” and making “a good-faith effort to contact an individual” using more than one means of communication before terminating their coverage based on the department’s mailed notice being returned to sender.

“How much this will impact Idaho Medicaid participants will not be fully known until we begin processing annual renewals during the unwinding period,” the department said in its unwinding plan.

A recent study of Medicaid data from Minnesota found that, when the state removed people from Medicaid after eligibility reviews, about half of them remained uninsured six months later and “a substantial share” had resumed their Medicaid coverage within one year.

“Many enrollees failed to seamlessly transition to new coverage, and a meaningful share of disenrollment may have been among enrollees who were eligible for Medicaid or experienced short-term changes in eligibility that did not persist for a full year,” the study authors wrote. “These transitions incur administrative costs for states and can disrupt access to care.”

Medicaid enrollees who are children, Latino, Black, female and in poverty are those most likely to lose coverage even though they’re still eligible, according to the federal predictions.

Removing children from Medicaid can be especially costly. A study of Phoenix-area health care claims, published in 2007 in the medical journal Pediatrics, found that removing 10% of children from Medicaid drove up health care costs by about $2,000 per child — not just for the child, but for the community as a whole.

Who qualifies for Medicaid in Idaho now?

Since Idaho’s expanded Medicaid took effect, following a ballot measure in 2018, the health care safety-net program has been available to all adults and children who meet income criteria and/or have disabilities.

The number of Idahoans on Medicaid grew in the past three years as people continued to join the program — but few people were dropped from the program each month.

Idaho Medicaid enrollment peaked at nearly 450,000 people this year — gaining about 150,000 people since March 2020, according to the Idaho Department of Health and Welfare.

The department is now about one-third of the way through reviewing, one-by-one, whether 153,857 of those individuals are still eligible for Medicaid.

Those who were about to lose their Medicaid coverage were directed to another option: Your Health Idaho, the state’s health insurance exchange where middle-income Idahoans can purchase private insurance plans with federal subsidies.

This story was produced by Boise-based nonprofit news outlet the Idaho Capital Sun, which is part of the States Newsroom nationwide reporting project. For more information, visit idahocapitalsun.com.