By Ella Mathews and Shreya Kalra
As Unwinding Wednesday readers know, our 50 State Unwinding Tracker is updated regularly as we monitor new information, specifically new unwinding data, provided by states. The tracker has evolved since we released it almost a year ago – both in the number of states publicly providing unwinding information and in the transparency elements we have detailed. Now that over two-thirds of states have some type of unwinding data available (compared to just four states when we first launched!), we have updated the format of the tracker yet again to reflect the variety of data being provided. We have also created a separate unwinding renewal data tracker to accompany these changes and help viewers make sense of the data. We continue to actively update documents and links found on the tracker, and while we see significant progress in data transparency, we aren’t finding new communications resources despite the need for updated messaging (we’ll come back to this later in the blog).
Updates to 50-State Unwinding Tracker
As our colleagues discussed a few weeks ago, some states have launched unwinding data dashboards or are releasing data in press statements while other states are posting the required monthly unwinding data reports submitted to CMS. Notably, almost half of the states (22) are posting both! Our 50-state tracker now separates these data materials into two columns: one with just the monthly reports to CMS and the other with other data posted by states. But nine states have yet to post any data.
Since nearly half of the states have both their monthly reports and other types of data posted, separating these data should make it easier to navigate our original (document) tracker and see when new data is posted. (Note: new data is indicated by bolded text and/or the date of the most recent dashboard updates). Despite the progress made on data transparency, 25 states have not publicly shared their monthly reports. These reports are essential for getting insight into how the unwinding process is unfolding especially in comparison to other states.
Launch of Monthly Unwinding Data Tracker
For the states where monthly CMS reports are available, we have aggregated and analyzed the data in our new State Unwinding Renewal Data tracker. To be clear, this tracker only shows data from the monthly reports and therefore does not include any other data from state press releases, dashboards, etc. Since states are required to report data in the monthly reports based on federal data specifications, these data provide the best comparison of the impact of the unwinding across states.
There are three ways to view the report data through the interactive data visualizations. The first shows the reported outcomes for all renewals due (measure 5 on the monthly reports). Many states have a high share of renewals still pending, so the second option takes a closer look only at renewals that were actually completed (those determined eligible, those determined ineligible, and those terminated for procedural reasons). Finally, the third selection reflects whether people lost coverage due to factual ineligibility vs. being disenrolled for procedural reasons. Spoiler alert: most terminations across states have largely been due to procedural reasons.
The data tracker is cumulative, combining data from all monthly reports that the state has available. The chart will be continually updated as states publish new data. The asterisks next to the state name reflect how many monthly data reports are included in the cumulative totals. As a reminder, we are also tracking state enrollment data for children, since the monthly reports do not provide data stratified by age group and very few states have published data on child disenrollments.
Review of Communications Materials from States
Unfortunately, our latest review of documents and links in our original unwinding tracker has found that unlike the data, most states have not kept up with updating their communications resources since the start of the unwinding. Many states’ communications toolkits indicated different phases of communications, with the “phase 1” message to update contact information getting heavy emphasis (rightly so) before and at the start of the unwinding. And while other phases were detailed in the initial plans for the unwinding and the state itself may have shifted messaging, some states have not updated their comms toolkits or pages for stakeholders to move to phase 2 messaging – “check your mail and return your renewal form promptly”.
There are a few good examples of states shifting their communications focus though. For example, Alabama published a Phase 3 Unwinding Toolkit in July, which guides providers in helping those who lost Medicaid coverage by ensuring ex-beneficiaries received and completed their renewal letter, and directing them to alternative coverage options. Additionally, some states have developed scam alerts and reporting tools in response to issues that have arisen in the first few months of the unwinding. Colorado created a “scam alert” toolkit to help protect enrollees and provide stakeholders with materials to inform enrollees of potential scams.
Our biggest disappointment though is the continued deficiency in messaging directed toward parents regarding children’s Medicaid coverage. Credit to North Dakota for having at least one child-specific message! As we have explained, in many states there is a significant difference between parent and child eligibility levels; as a result, parents may not realize that even if they no longer qualify for coverage, their children are likely still eligible.
With the large number of procedural disenrollments we are seeing across the country, especially in non-expansion states, the need for communication materials highlighting children’s eligibility and the importance of keeping kids connected to coverage is greater than ever. States need to adapt accordingly, especially with back-to-school outreach opportunities right around the corner.
Ella Mathews is a Graduate Research Intern at the McCourt School of Public Policy’s Center for Children and Families and is earning her Masters of Science in Health and the Public Interest (HAPI).
Shreya Kalra is a Research Intern at the McCourt School of Public Policy’s Center for Children and Families and is earning her undergraduate degree from the Georgetown University School of Health.