Following the termination of the Public Health Emergency (“PHE”) as a result of COVID-19, and the continuous enrollment provisions put in place to ensure that Medicaid beneficiaries were able to receive Medicaid benefits through the PHE, states began to reimplement the renewal process – referred to by the Centers for Medicare & Medicaid Services (CMS) as an “unwinding”.

So far, since the start of the unwinding, KFF has estimated that approximately 17.7 million beneficiaries have been disenrolled from Medicaid/Chip programs as of March 4, 2024 since the start of the unwinding, which began in March 2023. This figure represents approximately 20% of persons enrolled in the Medicaid/Chip programs. According to KFF, there are almost 40 million renewals remaining to be processed.

States vary widely in the degree to which the unwinding has affected their Medicaid beneficiaries and the number of remaining beneficiaries who have yet to go through the renewal process. But what is clear across the board in looking at the renewal process is that many of the terminations are a result of “procedural reasons” versus an affirmative determination of ineligibility by the state Medicaid agency. According to KFF, 70% of those disenrolled from Medicaid/Chip were terminated for “procedural reasons”.

What are these “procedural reasons”? It is caused primarily by the beneficiaries (or legal agents) not receiving the renewal forms or not completing them timely. In our firm, we see this on a daily basis. It is not uncommon for persons to be terminated from Medicaid coverage because funds accumulated in a bank account during the pause in the renewal process resulted in them accumulating assets which now place them over the state’s resource limits (i.e., determined to be ineligible, not for a “procedural reason”). It is also not uncommon for persons to be terminated from coverage due to a failure of the beneficiary of their legal agent to respond at all to the Medicaid agency’s request for updated information about the beneficiary’s financial situation (i.e., terminated for a “procedural reason”).

This unwinding/renewal process, and the resulting disenrollments, have caused headaches and cash flow issues for skilled nursing facilities. There are ways that skilled nursing facilities can lessen the risk of future terminations of their residents, however. These include:

• Talk to the resident or his/her legal agent or family members now about the renewal process. In many instances, family members are not familiar with this process. Warning the resident and family members about this process, and the need to respond to such timely (and risk of losing benefits) can go a long way to including them in the process and securing their cooperation in the renewal process.
• Make sure to get updated contact information. A lot of people (understandably) may think that once approved for Medicaid benefits, there is nothing further that would need to be done in the coming years to ensure that eligibility is continued. The initial Medicaid eligibility process can oftentimes be so arduous, it is understandable that persons not familiar with the Medicaid process would not imagine there would be yearly requirements to ensure eligibility would continue for their loved one.
• Talk to their resident and family members about the basic eligibility requirements and resource limits and remind them that the resource limit is an ongoing requirement and any resources over the limit must be spent down (in a Medicaid compliant manner) as soon as possible.

It was anticipated that the unwinding process would result in millions of people being disenrolled from Medicaid benefits and this has proven true. In many instances these are the very people who have no other payor source, and still require Medicaid benefits to meet their basic health needs, as much now as during the PHE. As we so often see, it is skilled nursing facilities, unfortunately, which bear the brunt of any fallout, here as a result of the unwinding. Taking some basic precautionary measures to respond to the post-PHE renewal process can do much to help the bottom line of skilled nursing facilities.

https://www.kff.org/medicaid/issue-brief/medicaid-enrollment-and-unwinding-tracker/ - medicaid-disenrollments