Last Friday marked the end of the month, which meant the release of new unwinding data from CMS. This time, though, CMS not only published data on renewal outcomes for June, but also posted preliminary outcome data for July, cutting the time lag to two months. As a result, there is now unwinding data available for all 50 states (!), all of which has been updated on our unwinding renewal outcome tracker.
With the renewal outcome data, CMS posted June call center statistics for all states as well as new data on transfers to the marketplace and separate CHIP enrollment. The call center statistics are useful in seeing trends and helping to answer the following questions: Is call volume increasing as more enrollees are getting renewals? Are call abandonment rates increasing as call wait times are going up? However, intel in the field indicates that the data may not be completely consistent with enrollee’s actual experiences with call centers, with reports of call wait times much longer than average statistics reflect.
In addition to the unwinding data, monthly enrollment data was released last week. We have discussed the importance of data for monitoring the unwinding across states. So, more than six months into the process and with at least one month of 50-state data available, what can we glean about the unwinding? Keep in mind, our cumulative tracker includes only 1 or 2 months of data or as many as 5 or 6 months for states depending on when the state began unwinding and whether or not the state posts data in advance of CMS.
Let’s start with the data that has been the primary focus of most unwinding discussions– renewal outcomes. The share of individuals determined eligible for Medicaid, of total renewals due, has improved but remains at less than half (48.7%). To some extent, the improvement stems from states that have completed early phases targeting enrollees likely to be no longer eligible. It may also reflect state efforts to boost targeted outreach to enrollees at risk of disenrollment.
Nearly one quarter of renewals (23.3%) have been reported as pending. Some of these reflect renewals that have been received but not yet processed, potentially indicating a backlog. The cumulative number of pending renewals is one of the required reporting unwinding metrics (#7) but unfortunately, CMS has not been posting these data. The pending number also includes states that have taken up the option to delay procedural disenrollments for 30 days to conduct targeted outreach. Therefore, it is difficult to tell whether high shares of pending renewals are due to a potential backlog or the state holding renewals for some reason, including the 30-day option.
This leaves disenrollment at 28% of individuals, notably higher than the 17-18% of Medicaid enrollees expected to be disenrolled based on prior projections by several researchers. Of those, nearly half (45%) of all enrollees and 3 out of every 4 children are expected to be disenrolled despite remaining eligible according to ASPE. If trends continue, disenrollment could be much larger than estimated by researchers. Based on the latest data, nearly 74% of disenrollments are based on procedural reasons. As we have written previously, these high rates of procedural disenrollments are especially concerning for children, who we know are likely to remain eligible for coverage. However, if the outcome of pending renewals skews toward eligible vs disenrolled as pending renewals are processed, the disenrollment share may decrease over time.
We have often highlighted in our many Unwinding Wednesdays the lack of data broken out by age to monitor how children are faring in the unwinding. To get a better idea of this, we have been tracking enrollment data, specifically child enrollment data. Based on the latest data available, child enrollment in Medicaid has declined by 1.63 million children since the start of the unwinding. Enrollment data provides the net change in enrollment (new enrollment minus disenrollment) so the actual number of children who have lost coverage is almost certainly higher than the data suggests. Looking at trends in application volume can also give us a sense if individuals are reenrolling in coverage. In June, 38 states saw an increase in application volume compared to the average application volume the year prior to the unwinding; of these, 27 states saw an increase of over ten percent. We plan to begin publicly tracking application volume soon, so more to come.
With the recently uncovered ex parte issue, the unwinding is likely to continue in some states beyond June 2024. Continuing to keep a close eye on the data is critical to identifying potential new problems and understanding where additional work and outreach may be needed.