Guaranteed continuous Medicaid coverage ending

A federal pandemic policy that guaranteed Medicaid coverage to hundreds of thousands of Connecticut residents is coming to an end.

Typically, people who receive Medicaid, known as HUSKY in Connecticut, go through an annual process to confirm whether they still qualify for the program. But, during the pandemic, the federal government instituted a policy, known as "continuous enrollment," that prevented states from kicking people off of Medicaid, even if they no longer qualified or failed to update their eligibility information.

But, on March 31, continuous enrollment will end, kicking off a year-long process called "unwinding," where everyone whose Medicaid coverage has been extended as part of the public health emergency will need to reevaluate their eligibility. In Connecticut, around 434,000 residents have had Medicaid coverage extended at some point over the past three years under the continuous eligibility rules.

"Just the numbers alone make this really challenging," said Sen. Matthew Lesser, D-Middletown, who chairs the Human Services Committee.

How will 'unwinding' work?

During a forum with the Human Services and Insurance committees in early February, Peter Hadler, a director with the Department of Social Services, presented the agency's plan for unwinding to legislators.

Hadler estimated that, once unwinding begins, DSS will have to process renewals for roughly 45,179 households per month, representing a nearly 70% increase over the volume of renewals the agency did last year.

But Hadler said the DSS has improved its ability to issue "passive renewals," a process by which the agency can automatically renew Medicaid coverage using data from the CT Department of Labor and the IRS. Passive renewals allow people to keep their Medicaid coverage without having to take any action.

"Because that passive renewal process has been strengthened going into the unwinding period, we're anticipating that a lot of people will now be able to passively renew," Hadler explained in an interview with the CT Mirror.

Sixty days prior to a person's renewal date, the state will attempt to passively renew their coverage. If this process is successful, the recipient will receive a notice that their coverage has been renewed and that no additional action is required.

DSS estimates that around 70% of households that need a renewal will be able to have their coverage passively renewed.

If the state cannot passively renew the coverage, the person will receive a pre-populated renewal application in the mail 45 days prior to their renewal date, which they will have to complete either online, by phone or on paper.

Even if the state is able to process most renewals "passively," this would still mean around 13,000 households per month would need to manually renew their Medicaid coverage through Access Health CT.

Potential challenges

Representatives from community health centers, which play a major role in helping people apply for Medicaid, shared concerns that the system will not be able to handle the volume of renewals that it will have to process during unwinding.

"The way things are going, the amount of time this is taking, we can only get to a few patients a day, and that's just not going to be feasible once the unwinding starts," Gilda DiScala, a certified application counselor at Fair Haven Community Health Center, told legislators during the forum in early February.

DiScala said completing a single renewal via Access Health CT's portal can take between one and two hours. Most of the time when she tries to help patients complete renewals online, the system kicks them off and prompts them to call Access Health CT directly to complete the application, further drawing out the process.

"Our patients know us, they trust us, they're coming to us, and we want to be able to assist them," she said.

Hadler said that DSS has hired over 100 new staff members to help with operations. The agency is also ramping up the number of contracted staff to support its shared operations with Access Health CT, including call centers and data entry.

Lesser said he worries about making people aware that they may have to renew their coverage in the first place.

"Connecting to folks and making sure that the people who need health insurance, who need health care, don't go without it is going to be a real challenge," said Lesser.

DSS and Access Health CT are in the process of running a campaign called "Update Us so we can Update U," which is designed to make folks aware that unwinding is coming. The campaign includes print and digital advertising, as well as direct email and automated call campaigns.

Who is at risk of losing Medicaid coverage?

Hadler said that adults on HUSKY A (coverage for low-income children and their parents and caretaker relatives) and HUSKY D (coverage for low-income adults without dependents) are most at-risk of losing their Medicaid coverage because their income has risen above the eligibility limits.

But even for those who no longer qualify for Medicaid, there are still options for low- and no-cost health insurance through the state.

About 51% of people on HUSKY A who no longer qualify will still get another year of HUSKY coverage through a program called Transitional Medical Assistance. Others who surpass the HUSKY income limits but still fall below 175% of the Federal Poverty Level may also qualify for a no cost plan through Covered CT. People can also purchase low-cost coverage through a qualified health plan.

Gov. Ned Lamont's proposed budget includes several initiatives aimed at smoothing the impacts of unwinding, including $34.4 million to support anticipated growth of the Covered CT program, $10 million in ARPA funding to pay for two months of premiums for individuals with income between 175 and 200% of FPL who enroll in an Access HealthCT silver plan, and $4.7 million to support costs associated with unwinding.