States are just emerging from the unwinding of the pandemic-related Medicaid continuous enrollment provision when HR 1 presents a host of state budget impacts and new administrative hurdles for states. If states are already having trouble keeping up with their eligibility and enrollment administrative workload, adding work reporting requirements, six-month renewals, and mandatory cost sharing requirements for adults in the expansion population will only exacerbate the situation. While only the 41 states that have implemented the adult expansion will have the heaviest lift, all states will have new administrative tasks and may make other changes to deal with budget shortfalls and changes to immigrant eligibility. So, how can we assess whether state Medicaid eligibility enterprises are ready to tackle additional administrative tasks? Although we don’t have all the data that would paint a complete picture, we do have the Medicaid performance indicators that reflect various aspects of the state eligibility and enrollment processes.
Today, we are posting a new report on State Readiness for HR 1 and Work Reporting Requirements reflecting state performance on eight performance indicators posted monthly by the Centers for Medicare & Medicaid Services (CMS). We report quarterly averages of the state monthly data for each metric. States are then grouped in quartiles with the top quartile as best. Each state gets a red flag if its performance on any metric is in the bottom two quartiles as an indication or warning that the state may be encountering a systems issue or difficulty in managing the workload. The higher the number of red flags, the greater the likelihood the state will have additional challenges in administrating eligibility and enrollment and assisting applicants and enrollees.
Missouri, Illinois, and Montana top the list with 7 red flags each. One third of the states have six or more red flags, and over half (29 states) have red flags on at least half of these eight metrics: center wait times; call abandonment rates; applications processed in over 30 days; the overall renewal rate; the ex parte (automated) renewal rate; the share of enrollees disenrolled at renewal; the procedural disenrollment rate; and the share of pending renewals. Detailed descriptions of these metrics are included in the report. On the first tab below, we show each state’s total number of red flags. In the second tab, you’ll find the states most at risk with four or more red flags.
These national maps individually feature all eight metrics reflecting each state’s performance, also grouping states in quartiles. These data will be updated on a quarterly basis going forward.
In addition to the report, we are posting state-specific performance data in a new State Readiness for HR 1 Tracker, much like we did during the unwinding. As a starting point, we have trended out the eight indicators starting with January 2024. In this analysis, we are summing up monthly data into a quarterly average to even out anomalies that may occur month to month. It will also allow us to track these indicators over the longer span of time when impacts of the budget reconciliation law will occur. Please note that not all states had completed the unwinding in January 2024, so the first two quarters of data may include a state’s unwinding experience.
State level data is compared to the national median to show whether a state’s performance is above or below the national median. Although it is better to have higher overall renewal and ex parte rates than the median, it is better to have lower rates for the other six indicators. CCF will update these metrics on a quarterly basis going forward if CMS continues to post the data. More details about our analysis can be found in the methods section of the new report.