CMS, States Point Fingers Over Medicaid Redetermination Errors

Medicaid eligibility redeterminations are in full swing, but many states have struggled to fulfill automated enrollment requirements mandated by CMS, leading to finger pointing and — at a minimum — hundreds of thousands of members getting kicked off insurance rolls when they should not have been. Experts and one managed care trade group say this unfortunate state of affairs was foreseeable and could have been prevented if state Medicaid agencies had adequate staff and technical resources. 

The problems with automated renewals began this spring, after a yearslong pause in eligibility checks mandated by the federal government in response to the COVID-19 pandemic. With states allowed to resume redeterminations as of April 1, millions of members who enjoyed ongoing Medicaid coverage without income eligibility checks during the COVID public health emergency are expected to be disenrolled because they now make too much money to qualify for the program. But, because of administrative reasons — most often missed paperwork sent by mail — it seems likely that many Medicaid enrollees have lost coverage even though they are still eligible, experts say.