Medicaid coverage gone for 150,000K Arizonans

Nearly 150,000 Arizonans have lost Medicaid coverage in a post-pandemic "unwinding process" and more than one-third of those people are younger than 19, new state data shows.

The people who have lost their Medicaid coverage in Arizona since April include 56,831 people under the age of 19, according to the Arizona Health Care Cost Containment System, which is Arizona's Medicaid program.

The numbers are "very concerning," said Matt Jewett, health policy director for the Phoenix-based Children's Action Alliance.

His organization is urging families to keep their addresses up to date with AHCCCS or their AHCCCS health plan. Anyone with questions may call 211 or go to coveraz.org, he said.

Medicaid is the single largest source of coverage for U.S. children, with 54.3% of all children in the country enrolled in Medicaid and CHIP, a report from Georgetown University's Center for Children and Families says.

Medicaid, a government health insurance program for low-income people, had lost more than 1 million members because of the post-pandemic unwinding nationwide as of June 14, according to KFF, an independent health policy research organization. The KFF analysis says the reported 1.15 million people who had lost coverage is likely an undercount because not all states have publicly available data on total disenrollments.

Health care advocates, as well as federal and state health officials, are trying to get the word out that a freeze on disenrollment in Medicaid that was in place during the COVID-19 pandemic is now over. The concern is that individuals and families, including children, will be left without health insurance coverage, which means an unexpected health emergency could result in crushing medical debt.

As of February, AHCCCS leaders had identified an estimated 674,460 people who were at risk of losing Medicaid coverage over the next year. The unwinding process is a huge undertaking in Arizona, as the program as of March enrolled 2.53 million people or one in every three state residents. Enrollment as of this month had declined to 2.36 million, or about 32% of the state's population, AHCCCS data shows.

Jewett said it's important for anyone who has lost coverage to know they have 90 days to resubmit their information and AHCCCS will be able to make a new determination without needing a whole new application.

Federal officials say they, too, are concerned by the number of people nationwide who are losing Medicaid coverage, and in particular that so many are getting kicked out of the program for "procedural" reasons, meaning they were disenrolled because of problems with paperwork, not with their eligibility.

The KFF data says about three-quarters of the people who have lost coverage to date were disenrolled due to procedural reasons and AHCCCS data shows a similar pattern in Arizona.

"High procedural disenrollment rates are concerning because many people who are disenrolled for these paperwork reasons may still be eligible for Medicaid coverage," the KFF analysis says.

AHCCCS officials said Wednesday that two months of data is not enough to draw any conclusions about the post-pandemic renewal process, which is often referred to as unwinding.

Disenrollment due mostly to red tape

Throughout the pandemic, state Medicaid programs across the country, including Arizona, froze disenrollment, which means the number of people enrolled in the program grew and grew, with few exceptions, generally only for death, voluntary disenrollment, moving out of state or aging out of programs with age limits.

But now that the federal public health emergency is over, states have lifted the freeze on disenrollment. Despite awareness campaigns, many people appear to be missing the message that they are at risk of losing coverage.

In Arizona, 78% of the 148,637 people who lost coverage since April were disenrolled for "procedural" reasons, AHCCCS data says. A procedural reason specifically means that either the person who was disenrolled did not provide the information needed to determine their ongoing eligibility, or they did not respond to a renewal form requesting information, AHCCCS officials say.

The state agency said it will take time to "more meaningfully understand" the overall rate of people in Arizona who lost coverage for procedural reasons.

Early data releases "cannot yet capture what these initial rates mean and reducing it to one global number ignores the reality that there are many different scenarios that are occurring," AHCCCS spokesperson Heidi Capriotti wrote in an email Wednesday.

For example, some people may have opted not to respond to a renewal notice because they've moved onto other health insurance plans through their employers or federal or state marketplace plans, Capriotti wrote. 

She emphasized that AHCCCS has protections in place for members who are discontinued, including a fair hearing process and a new 90-day reconsideration period during which people can be reinstated to coverage without starting a new application.

The other 22% of Arizonans who lost coverage since April were disenrolled due to what AHCCCS officials call "factual" reasons — they are longer eligible for the program for a variety of reasons such as making too much money or no longer being an Arizona resident.

The AHCCCS website has a section for frequently asked questions about the redetermination process. AHCCCS is asking all members to make sure their mailing address, phone number and email address on file are correct in Health-e-Arizona Plus. Enrollees may log in to www.healthearizonaplus.gov or call 1-855-HEA-PLUS (1-855-432-7587) from 7 a.m. to 6 p.m. Mondays through Fridays. Enrollees may sign up for text or email alerts from AHCCCS at www.healthearizonaplus.gov.

Federal health officials say health coverage for "millions of Americans is at risk." Officials with the Centers for Medicare & Medicaid Services say their goal is for everyone to have health insurance, whether it's through Medicaid, Medicare, employer-sponsored coverage, the Children's Health Insurance Program known as CHIP (called KidsCare in Arizona), or the marketplace created by the Affordable Care Act, often known as Obamacare insurance.

"As states are starting to get through their first set of Medicaid renewals, we are seeing a high rate of terminations," Dan Tsai, federal Center for Medicaid & CHIP Services director, told reporters in a June 12 telephone news conference.

"There are procedural barriers and red tape that have prevented folks, eligible people, from making it through the Medicaid renewal process. And so I don't think it's an exaggeration to say that millions of Americans' health care coverage is at risk. … We are are urging and asking states to do everything in their power to keep eligible people covered. It's not enough to just follow the minimum federal requirements, we need states to do more."

There's a special enrollment period for ACA coverage for qualified individuals and their families who lose Medicaid or KidsCare coverage that began March 31 and goes through July 31, 2024, federal officials recently announced.