First month of Medicaid ‘unwinding’ boots nearly 53K Hoosiers from coverage

Nearly 53,000 Hoosiers lost their Medicaid coverage this month, the first of many to lose their insurance following the "unwinding" of pandemic-related protections over the next year — and at a much higher pace than previously predicted.

The Family and Social Services Administration tasked with managing the state's Medicaid program promised it would use this first month to improve future disenrollment rates but for Rep. Ed Clere, R-New Albany, the numbers alone were "staggering."

"I'm just worried we're going to be learning as people lose coverage… and I don't want to learn at their expense," Clere said at this month's Medicaid Advisory Committee meeting.

States across the country will cull hundreds of thousands of Medicaid beneficiaries following the expiration of the federal public health emergency, which ended in April.

During the COVID-19 pandemic, the federal government incentivized states to keep their residents enrolled in Medicaid continually with an enhanced match.

A fraction of those removed were determined to be ineligible – 6,089 Hoosiers – while the vast majority, 46,896, were removed for procedural reasons. The redetermination process – known as the "unwinding" – will repeat every month until April 2024.

A previous estimate was that between 300,000-400,000 Hoosiers could lose their coverage over the entire period.

The Hoosiers who lost coverage due to procedural reasons can complete their renewal application within the next 90 days and receive retroactive coverage – unless they were members of the Healthy Indiana Plan (HIP) 2.0, which doesn't allow for retroactive coverage.

FSSA leaders indicated that they believed some Hoosiers would ultimately regain their coverage, but didn't have any estimates.

Coverage stems from pandemic provision

According to the Family and Social Services Administration (FSSA), Indiana's Medicaid enrollment grew from 1.4 million prior to the pandemic to more than 2.2 million in April, the first month the agency could redetermine eligibility and remove Hoosiers from the rolls.

"We've traditionally said about one in five Hoosiers are on Medicaid," said Nonis Spinner, FSSA's director of eligibility and member services. "Now, it's closer to one in three Hoosiers."

In April, 157,688 Hoosiers were up for renewal and just 65,092 were successfully renewed and 52,985 Hoosiers lost their Medicaid coverage. Another 39,611 Hoosiers up for renewal in April had incomplete renewal applications as of Wednesday and haven't been re-enrolled or terminated.

Previously, FSSA said it started sending out reminders to enrollees in December, advising them to update their contact information to ease the redetermination process. Those who submitted their most recent information had their coverage renewed faster.

Of the 65,092 Hoosiers who were renewed, 40,752 were renewed automatically.

According to the agency's presentation, 39,057 previously enrolled members received text messages reminding them to update their information in addition to the mailed reminder. The agency also made 15,176 outbound calls and sent 16,624 emails.

Individual messages or calls may cover multiple members of one household, FSSA noted.

Spinner said the agency hoped the numbers of Hoosiers who lost Medicaid coverage would decrease in the coming months, as members shared their experiences with each other and response rates increased.

"This is an unfortunate reminder," Spinner said. "We're hoping that a lot of those individuals see that and renew so we end up not having that total number of disenrollments each month."

Additionally, the federal government will provide aggregate numbers in the coming months for the numbers of Hoosiers previously on Medicaid who purchased an individual plan on the health insurance marketplace or opted into an employer plan, Spinner said.

"We're in the early days; we do hope to get a lot more data on all of the various moving pieces," she said.

Spinner noted that the health policy non-profit KFF ranked states on their Medicaid unwinding policy plans, placing Indiana in the upper tier of states who met all of the criteria to promote continued coverage through the unwinding.

Indiana was only docked for not granting continuous coverage up to adulthood for children – a policy the General Assembly codified earlier this year that will go into effect starting in 2024.

Lawmakers attending the meeting expressed concern about the drop in enrollment – especially the unknown number of children impacted – while others wondered if the "procedural" reasons included FSSA mishaps or confusion from beneficiaries.

"We will learn and we will find things we can do better," Spinner said.