Unwinding Wednesday #7: Key Data to Monitor Unwinding of the Medicaid Continuous Coverage Protection (Part 1)

The ninth webinar in our unwinding series with the Center on Budget and Policy Priorities focused on three sources of data to monitor the impact as states begin to process disenrollments once the Medicaid continuous coverage provision is lifted. We discussed 1) the data that states have been required to report as part of the performance indicator project; 2) the supplemental unwinding data that states will be required to report to CMS during the unwinding; and 3) monitoring social media channels to find mentions and conversations about consumer issues. Today’s blog will focus on the performance indicator data.

The performance indicator project is a CMS initiative to collect, use, and share data on key Medicaid and CHIP business processes – including applications, renewals, eligibility determinations, and enrollment. I’ve written about the performance indicator data a number of times on Say Ahhh! because it was an exciting step forward as states prepared for implementation of the ACA’s Medicaid expansion and other changes to Medicaid. The performance indicator project was first announced in 2013, requiring states to report baseline data as of September 30, 2013 and monthly thereafter. The list of performance indicators was updated and accompanied by the release of a detailed data dictionary in May 2014. The performance indicators include 80 data points categorized in 11 topic areas. States are required to report data by the 8th of the month for the prior month.

The performance indicator data is the source of CMS’ enrollment snapshots, which include national data on applications, enrollment, and account transfers. State level enrollment and application data is posted on data.Medicaid.gov. Additionally, CMS has published an annual state-level three-month snapshot of application processing times for the past five years, and has indicated these data will be published on a quarterly basis going forward.

However, CMS has yet to report call center data, which is one of the most important types of performance indicators to monitor the unwinding; as I have repeatedly said, it’s the canary in the coalmine. Tracking and trending call center data is needed to ensure that as call volume increases, call center wait times remain reasonable. Keep in mind that low-wage earners often work service jobs or multiple part-time jobs meaning they simply cannot sit at their desks and multi-task while they are on hold. Yet, it’s not unusual for us to hear anecdotal reports of call wait times not in minutes but in hours! If enrollees can’t get answers to questions, they may fall through the cracks and join the ranks of the uninsured.

The performance indicator data can also provide insights into the state’s capacity to manage the workload by trending application, account transfer, and renewal data, including keeping an eye on whether the number of pending applications or determinations is growing. Trending the enrollment data will provide a sense of how many people are being disenrolled each month, but it doesn’t tell us why – that is, whether they are ineligible or lost coverage for procedural reasons.

While the historical performance indicator data is useful for mining past trends, the lag in data reporting (CMS has only posted final May data as of mid-October) is not timely enough to hit the pause button if the unwinding is not going well. And call center data, among other key pieces of performance indicator data, is not currently published by CMS.

Some states publicly post certain performance indicators, most often enrollment data, on their own and often on a more-timely basis than CMS. CCF has been monitoring state published enrollment data since we were tracking the Medicaid child enrollment decline back in 2018 and 2019. We’ll continue to do so and share our findings when the unwinding begins.

Without timely public reporting of data to monitor the unwinding, a lot of damage can be done before it becomes apparent that large numbers of eligible enrollees are losing coverage for procedural reasons. Stakeholders should encourage their states to be transparent and accountable in posting these critical data. To this end, a few states have indicated they plan to launch an unwinding data dashboard or otherwise publicly share key data. However, at least a couple of states have indicated that they intend to create a data dashboard for internal use only. Also, we have heard that in some states, the human services agency, which has responsibility for Medicaid eligibility units and call centers, is balking at sharing call center data. In these cases, one option is to conduct your own secret shopper survey to track call wait times on random days and times to get a sense of whether enrollees may be encountering difficulty getting assistance.

If you’d like to hear more about key metrics to monitor during the unwinding, you’ll find the recording and slides for the webinar here. Stay tuned for next week’s Unwinding Wednesday when my colleague, Allie Gardner, will talk more about the unwinding supplemental data that states are required to report to CMS when the continuous coverage protection is lifted.

[Editor’s Note: For more information, visit our PHE Unwinding resource page where you’ll find other blogs in this series, reports, and the 50-state tracker.]