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'The unwinding': Idaho Medicaid must recheck eligibility for 131K people when U.S. emergency ends

Idaho has 420,000 people on Medicaid, but once the emergency ends, 131,000 people currently on protected status will be re-evaluated.
The Idaho Department of Health and Welfare

BOISE, Idaho —

This story originally appeared in the Idaho Press. 

Since January of 2020, the nation has been under a public health emergency declaration for the coronavirus pandemic, and as a result, states have been forbidden from kicking people off of Medicaid because their income or other eligibility criteria changed.

Currently, 131,000 Idaho Medicaid recipients qualify for that “Medicaid protection,” meaning the state can’t force them to resubmit their proof of eligibility until the public health emergency lifts. However, the Idaho Department of Health and Welfare doesn’t know how many of those recipients actually still qualify, and how many don’t.

Idaho qualified for an increased federal matching rate for its state-federal Medicaid program during the public health emergency; Medicaid pays for subsidized health care for low-income and disabled Idahoans. “But the caveat of that for Idaho was you can’t disenroll people,” said Shane Leach, administrator for the Division of Welfare at IDHW.

It’s actually possible that all of them still fall within the eligibility criteria, Leach said. “We really don’t know until we actually get a hold of them. My guess is it’s going to be a mixed bag.”

States across the country have been bracing for a big wave of re-evaluations of existing Medicaid patients once the emergency lifts, and the Idaho Board of Health and Welfare is set to receive a briefing on the process at its Thursday morning meeting. But Leach said the federal emergency declaration isn’t ending anytime soon.

“We don’t know when it’s going to end,” Leach told the Idaho Press. “It keeps coming, and they keep extending it for another 90 days.”

The last 90-day extension was on July 15, according to the U.S. Department of Health & Human Services. That means the earliest possible date the national emergency declaration could end is Oct. 15.

“They’re supposed to actually let us know this week whether or not it’s going to end in October,” Leach said. “But the last two times, they didn’t come out and officially say it’s extended on that day. They promised us at least 60 days before they ended it they’d give us notice. … Everybody’s really confident that they’re going to extend it again, likely till the end of the year. But I don’t know. I’ve given up guessing.”

“We keep getting ready for it, we’re prepared, and then they come out and say they’re extending it for another three months,” he said.

Idaho has 420,000 people on Medicaid in all. Once the emergency ends, it will begin a process of re-evaluating the eligibility of the 131,000 people currently on protected status.

“A lot of states just actually stopped doing redeterminations altogether when the public health emergency came out,” Leach said. “We in Idaho never stopped. … We kept going on an annual basis.”

Idaho Medicaid recipients face a redetermination process every 12 months they’re on the subsidized federal-state health insurance program. “We check their income, family size, all those things, to see if anything’s changed and see if they’re still eligible or not,” Leach said. “We are still doing re-evaluations every month.”

But normally, if someone doesn’t respond to the request to re-qualify, they automatically get cut off. That hasn’t happened during the emergency. So the 131,000 figure represents those who haven’t responded. During the emergency, the only reasons people can be removed from Idaho’s Medicaid rolls are death, removal at their own request, or signing up for Medicaid in another state.

“If someone’s eligible, we want to make sure they remain eligible,” Leach said. “But we can only do so much. It’s kind of like we can lead the horse to water. If they don’t help us and give us what we need, they may close,” meaning their coverage could end.

Idaho does have 90-day retroactivity, meaning if someone is cut off from Medicaid in error, such as a change in contact information causing them to miss the redetermination notice, they can still get coverage if they request it or seek care within 90 days. “So there’s a little bit of a window there,” Leach said.

Outside of the emergency period, when recipients are found no longer eligible, they’re referred to the Your Health Idaho health insurance exchange to purchase health insurance, for which they may qualify for a tax credit. If they just don’t respond to a redetermination request, they’re cut off.

Idaho Health and Welfare spokesman Greg Stahl said there are currently 420,000 Idahoans on Medicaid.

Leach said once the emergency ends, the department will be overwhelmed with the sudden deluge of redeterminations. It’s planning to process them in groups of 25,000 to 30,000 a month.

“We’ll start contacting them at least 60 days before, letting them know what they have to do,” he said. “We’re going to send multiple notices.”

Leach said states across the country are in the same boat. “They’re calling it ‘the unwinding,’” he said.

Thursday’s briefing to the state Board of Health and Welfare doesn’t require any action; it’s just letting the board know what’s in store and the plans. “This is kind of our high-level plan of how we’re going to do the redetermination once it actually ends,” Leach said.

Betsy Z. Russell is the Boise bureau chief and state capitol reporter for the Idaho Press and Adams Publishing Group. Follow her on Twitter at @BetsyZRussell.

This story originally appeared in the Idaho Press. Read more at IdahoPress.com 

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