We recently learned that one of the most effective tools for keeping eligible people enrolled in Medicaid – automated or “ex parte” renewals – has not been set up correctly in 30 states, including DC, while other states, such as Texas, are barely using automated systems at all. As Say Ahhh! readers know, Medicaid eligibility differs significantly by state and is set at higher income levels for children than adults. That is why children are far more likely to lose coverage due to this flaw, which determines eligibility on a household basis rather than an individual basis. When eligible children were lumped in with the entire household, they were not auto-renewed as they should have been. Instead, their families were sent a complicated renewal package with confusing information and many parents likely assumed that if they were no longer eligible, their children would not be eligible either. We call that the “unwelcome mat” effect.
Whether, or not the packets ever reached these families is another issue. Meanwhile, those seeking help to overcome the administrative barriers to Medicaid coverage likely encountered long wait times as Medicaid call centers face their own challenges keeping up with consumer demand.
While HHS took swift action to address these errors, pause procedural disenrollments for impacted groups, and reinstate coverage for eligible children and others who were erroneously disenrolled, it will take time to get this sorted out and other unwinding issues could bubble up in the meantime. (A federal government shutdown would exacerbate an already bad situation.)
Even in states without the ex parte errors, the Medicaid renewal process can be extremely confusing for families who don’t know whether or not they or their children are still eligible for Medicaid, what steps they need to take to keep their coverage, and what rights they have if they have lost Medicaid coverage. Families need trusted messengers to help them navigate through this complicated process and, fortunately, they have some who are willing to help.
Georgetown University CCF teamed up with its long-standing partner, the American Academy of Pediatrics (AAP), to develop outreach materials and get them into the hands of trusted messengers such as pediatricians. Together with GMMB, our communications partner, we created consumer-facing flyers with state-specific information in Spanish and English.
We identified the lack of information about the variation between child and adult income eligibility guidelines as a barrier to coverage and addressed it by including eligibility information on the first set of flyers. The median child eligibility limit is 255 percent of the federal poverty line ($5,283 per month for a family of three) compared to 37 percent ($767 per month) for parents in non-expansion states and 138 percent FPL ($2,859 per month) for parents in expansion states. You can understand why a parent whose income exceeds the adult income guidelines may not realize their child is still eligible. To help inform parents that even if they are not eligible, their children might be, we created these state-specific renewal flyers, which include income eligibility guidelines.
As the unwinding progressed and millions of people lost Medicaid, we updated the messaging on existing resources. The updated information in this set of flyers is designed to help families understand options for re-enrolling, appealing disenrollment determinations, and transitioning to other sources of affordable, comprehensive coverage such as the Children’s Health Insurance Program (CHIP). GMMB also updated the graphics and consumer-facing messaging in the Template re-enrollment toolkit to stress the urgency to enrollees and outline options for those who have lost coverage. Again, these resources are all offered in English and Spanish.
Visit Georgetown CCF’s Medicaid unwinding resource page to access these and a large collection of other resources for our partners including a toolkit created by the School Superintendents Association (ASSA) to help school personnel inform parents about renewing their children’s Medicaid coverage. We also feature a wide variety of coverage-related resources available from CMS in multiple languages.
We will continue updating these resources and developing new materials as the situation demands in an effort to keep the doors to Medicaid coverage open even when some of the automatic doors are malfunctioning.