New from CCF: State Shares of Medicaid/CHIP MAGI Applications Exceeding 45-Day Processing Standard

Federal regulations establish a 45-day standard for acting on Medicaid applications for low-income children, families, and adults (also known as MAGI groups). Applications for MAGI groups are considered untimely and out of compliance with federal rules if processed after the 45-day standard. Just this week, CCF posted new maps that show month-by-month data reflecting the share of untimely applications processed by states during the unwinding of the COVID-related Medicaid continuous enrollment requirement. A growing share of untimely applications may indicate that state Medicaid agencies are encountering challenges in staying on top of their workloads.

One thing that’s important to keep in mind: application data includes new applicants as well as individuals who submit verifications needed for renewal after being procedurally disenrolled. This is one of the reasons why we are also seeing an increase in application volume reported by states. CCF continues to update the number of applications reported by states for each month during the unwinding, which is the most recent addition to the tranche of state level data we post.

As I wrote in this blog, states have been required to report application volume and processing times as part of the performance indicators required of states since 2014. Like increasing call center volume and wait times are a canary in the coalmine, increases in the share of applications and application processing times also provide insight into whether a state’s capacity is being stretched beyond its ability to manage the workload efficiently and effectively without undue delays. As timeliness in acting on applications slips, applicants and individuals trying to re-enroll get frustrated and add to call center volume and stress for call center and eligibility workers. And that stress snowballs.

While two-thirds of states report less than 10% of applications are taking more than 45 days to process, data for a handful of states suggest a serious concern when a third or more of applications cannot be completed on time. In fact, in Georgia, Missouri, New Mexico, and D.C., over 40 percent of applications are taking more than 45 days to process. And while application volume nationwide dropped in November, after a significant jump between September and October, the number of applications received by Medicaid and CHIP agencies increased in 20 of 50 states, including D.C, in November.

Although almost all states will be initiating their last batch of monthly renewals in March, with the lag in data reporting and anticipated increases in re-enrollment efforts, we know we’re not done with the unwinding yet. But as the unwinding begins to wind down, it will be important for states and stakeholders to take steps to help eligible kids and families who have lost coverage get it back.

Tricia Brooks is a Research Professor at the Center for Children and Families (CCF), part of the McCourt School of Public Policy at Georgetown University.