Mississippi's Medicaid enrollment returns to pre-pandemic levels following COVID spike

A COVID-era federal law prevented states from checking eligibility for Medicaid enrollment over a 3-year period, leading to a large spike in Medicaid enrollment. In 2023, states began checking for eligibility again.

Mississippi's Medicaid and Children's Health Insurance Program (CHIP) enrollment spiked during COVID by nearly 190,000 residents, a 26 percent increase. The end of a COVID-era law, one which prevented states from checking the income eligibility of individuals enrolled for three years, has seen the state's Medicaid enrollment fall to near pre-pandemic levels.

Back in March of 2020, the federal government enacted the Families First Coronavirus Response Act at the start of the COVID pandemic. Among the law's many provisions was a policy known as "continuous coverage." The provision prevented states from removing people from Medicaid once enrolled, regardless of whether income changes during the pandemic made them ineligible.

In exchange, the federal government increased the "Federal Medical Assistance Percentage" by 6.2 percent during the period of continuous coverage, meaning that states received more federal dollars to help fund their Medicaid programs.

"I would say the financial benefit of the FMAP increase outweighed the additional cost of the 26 percent enrollment growth (during the pandemic)," Drew Snyder, Executive Director of the Mississippi Division of Medicaid, told Magnolia Tribune. Snyder pointed out that young people on the rolls of CHIP were less likely to be heavy users of their coverage.

As part of the Consolidated Appropriations Act, Congress set a deadline of March 31, 2023, to end "continuous coverage." On April 1st of last year, states began checking eligibility for Medicaid and CHIP enrollment, again. The process has been referred to as "unwinding," and is occurring not just in Mississippi, but across the nation.

There are two primary categories of ineligible individuals being disenrolled; those who are turning in renewal paperwork, but who make too much income to be enrolled, and those who are not returning renewal paperwork verifying their income eligibility (sometimes called "procedural disenrollment").

Snyder said that during the unwinding period, the number of Mississippians enrolled in Medicaid and CHIP decreased by nearly 190,000, returning enrollment to just slightly above pre-pandemic levels.

Before the pandemic, 716,896 residents of the Magnolia State were receiving Medicaid or CHIP benefits. At the height of the pandemic, Mississippi had nearly 904,700 people enrolled in either of those programs. Today that number is 718,028.

"Basically by the end of the unwinding period we had about 718,000 people enrolled, so a lot of the folks who were disenrolled were very likely to be ineligible when those re-verifications were restarted," Snyder described.

Snyder noted that when eligibility determinations resumed in 2023, about 45,000 young adults aged out of qualifying to receive CHIP benefits.

Another category of recipient that led to the COVID-era spike was women who were pregnant when the pandemic began. When the pandemic began, a pregnant woman earning up to 194 percent of the federal poverty level was eligible for Medicaid coverage, including 60 days of postpartum coverage. The FFCRA's "continuous coverage," however, meant that woman was maintained on the Medicaid rolls until March of last year.

"So let's say we have someone who was on the rolls in January of 2020 who gave birth, that coverage would have normally ended at the end of March 2020, but when continuous coverage occurred, that coverage would go on [until March of 2023]," said Snyder.

The Mississippi Legislature in 2023 expanded the duration of postpartum Medicaid coverage to a year.

Snyder also said that some people are confusing disenrollment, with a lack of coverage.

"I think one thing that also gets missed in the discussion about this, is there is a difference between losing insurance coverage and no longer qualifying for Medicaid."

Some who were on Medicaid during the three-year continuous coverage period became employed and obtained employer sponsored health insurance. others have turned to the ACA exchange to find coverage. The ACA exchange is a government subsidized marketplace where individuals can obtain private individual health insurance.

"A lot of the narrative focuses on how many people had been disenrolled from Medicaid during the unwinding, but not as much attention was placed on how many people gained coverage during this continuous coverage requirement," Snyder stated.

Anyone who has lost coverage, but feels they still qualify, can provide the necessary information and documents at their local Medicaid office, or online.

Snyder said for most of the population, income is a driving factor determining eligibility, but a person's age and disability status are also factors. Online renewals and reaching out to recipients via email and text messaging are new features added to Mississippi's Medicaid Division post-pandemic.

"There's been a concerted effort to improve awareness and make it easier to keep coverage," Snyder described.

-- Article credit to Jeremy Pittari of the Magnolia Tribune