Survey Shows States Made Significant Progress Implementing Data-Driven Eligibility in Medicaid

Eligibility decisions made in real-time or overnight when someone submits a Medicaid application? Automated determinations of ongoing eligibility at renewal without requiring enrollees to fill out forms or send in paperwork? It wasn’t too long ago that many Medicaid stakeholders would have thought those were pie-in-the sky notions. Yet, thanks to new high-performing eligibility systems and new rules modernizing how states manage their Medicaid programs, data-driven eligibility is becoming a reality.

Last week, the Kaiser Family Foundation and CCF released the annual 50-State Survey on Medicaid and CHIP Eligibility, Enrollment, Renewal, and Cost-Sharing Policies. The survey findings illustrate the significant progress states have achieved in using reliable sources of electronic data to make real-time eligibility determinations and implement highly automated renewal processes.

The report brings to mind the remarks of CCF founder and former head of Medicaid at CMS, Cindy Mann, during CCF’s annual conference in 2010 just after the Affordable Care Act was enacted.  “This isn’t your mother’s Medicaid anymore,” she said back then.  Indeed it is not. And it’s important to note that gains that states are making are both administratively efficient and consumer-friendly, a win-win for states and enrollees. Here are the details:

More than two-thirds of states (37) report they can make real-time Medicaid eligibility determinations (defined as less than 24 hours) for children, pregnant women, and nondisabled adults. Among the 27 states that were able to report the share of applications for these groups that receive a real-time determination, 11 indicated that more than 50% of applications receive a determination in real time.

A total of 34 states report they can complete automatic or ex parte renewals by using information from electronic data sources, as outlined in the ACA. Among the 26 states that can report the share of renewals completed using automated processes, 10 indicate that over 50% of enrollees are automatically renewed, including three that report automatic renewal rates above 75%. Keep in mind that these statistics relate only to MAGI-based populations, which includes children, pregnant women, parents, and expansion adults.

Other findings in the report include:

  • Medicaid and CHIP remained the central sources of coverage for low-income children and pregnant women nationwide during 2015.
  • Medicaid’s role for low-income adults continued to grow through the ACA Medicaid expansion.
  • Eligibility levels vary across groups and states, and state Medicaid expansion decisions have increased these differences.
  • Individuals can apply for Medicaid online or by phone in nearly all states as envisioned by the ACA
  • States expanded functionalities of online applications and accounts during 2015.
  • Coordination between state Medicaid agencies and the Marketplaces improved during 2015, but challenges remain.
  • As implementation continues, a number of states eliminated delays in processing renewals and put streamlined renewal procedures in place as established by the ACA.
  • Premiums and cost-sharing in Medicaid and CHIP remain limited, although under waiver authority a few states are charging higher levels than otherwise allowed under federal law.

The report was released at a public briefing that included CMS Medicaid Director Vikki Wachino and state officials from Alabama, Gretel Felton, and Colorado, Chris Underwood. The full report is available here and you can watch a video of the briefing  below.