Nearly 3,180 Granite Staters get Medicaid back under new federal guidance

The state Department of Health and Human Services has reinstated Medicaid insurance for 3,176 people, including 1,351 children, based on new eligibility guidance from the federal government. The change will also allow nearly 1,200 people who are up for renewal in October to keep their Medicaid, said Medicaid Director Henry Lipman.

"We certainly see this as an opportunity to help some additional people get back to Medicaid coverage," he said.

The situation is not unique to New Hampshire.

In August, Daniel Tsai, director of the Center for Medicaid and CHIP Services, the federal children's health insurance program, sent a letter to Medicaid directors in every state with several directives: They were to immediately review cases for inadvertent terminations; reinstate Medicaid for anyone who remains eligible; and fix systems or processes that led to those terminations.

The agency warned failure to do so would lead to unspecified "compliance action."

Lipman said his office has reviewed the state's process for determining eligibility in response to the CMS guidance and will reinstate Medicaid coverage by the end of September for the 3,176 people it disenrolled.

Meanwhile, Lipman's office is launching a separate effort to partner with schools and after-school programs to ensure families have access to Medicaid-covered services.

The 3,176 individuals who will see their Medicaid reinstated represent about 2.8 percent of the more than 113,000 eligibility redeterminations DHHS has done since April 1, when the federal government allowed states to resume annual reviews after a three-year hiatus.

Lipman said the state has adjusted its eligibility review procedures as required.

The updated guidance from CMS pertains to cases involving "ex parte" eligibility reviews where states are required to use information they already have about a Medicaid holder to assess whether they remain eligible. The policy is aimed at allowing people who are eligible for coverage to keep it without having to go through what can be a complicated eligibility redetermination process.

In a press briefing, Tsai said the agency became concerned that some ex parte reviews were resulting in states overlooking idiosyncrasies in individual cases that would have preserved Medicaid coverage.

He offered the example of a single parent whose income exceeds the eligibility limit for adults but is low enough for the child to qualify because the income limit for children is higher.

"The issue has a disproportionate impact on children," Tsai said. "And I want to be clear: CMS is stepping in to make sure children and families have the coverage they need."

In addition to reinstating Medicaid for the 3,176 who were disenrolled, the state will cover the Medicaid-eligible medical bills they incurred while they did not have coverage but should have under the new guidance.

During the press briefing in August, Tsai declined to estimate how many people may see their Medicaid reinstated under the new guidance. In an email last week, CMS said it is still reviewing states' responses and will release a preliminary analysis soon.

Lipman said the 3,176 terminations in New Hampshire were not intentional but rather based on the state's interpretation of complex Medicaid eligibility rules that factor in more than income. States must also consider disabilities, pregnancy, and the age of a child being cared for. Income limits can range from 138 to 318 percent of the federal poverty level, depending on individual circumstances.

Lipman said CMS audits states regularly for compliance with Medicaid eligibility rules, among other aspects of the program. He said this is the first time the agency has flagged this specific policy of performing an additional income eligibility assessment.

"I think part of it is the density of the federal regulations and the nuances," Lipman said. "If you pick them up and try to read them, you can feel like you're in compliance."

In New Hampshire, fewer children than adults lost coverage, 1,351 compared to 1,825, between April 1 and Aug. 31, Lipman said. Of those, nearly 1,180 were disenrolled in September, meaning they will have been without coverage for only a few weeks once everyone is reinstated by the end of the month, Lipman said.

The department believes about half of the 3,176 people whose benefits are being reinstated may have incurred few or no medical expenses while disenrolled because they had used their Medicaid coverage so infrequently in the four months before their coverage ended.

No one living in long-term care settings or receiving care at home or in a community setting, a group that relies heavily on Medicaid coverage, improperly lost coverage, Lipman said.

Medicaid eligibility reviews have been especially challenging for states this year for two reasons.

They saw their Medicaid populations skyrocket during the pandemic when people lost jobs or had to stay home to care for a child or sick family member. New Hampshire's enrollment for Medicaid and expanded Medicaid increased 86 percent, from 51,000 people to over 95,000.

And, during the nearly three-year federal public health emergency, the CMS prohibited states that accepted higher Medicaid payments, which New Hampshire did, from continuing annual eligibility determinations and disenrolling anyone who no longer qualified.

That left states looking at more eligibility redeterminations than ever before in April. Just over 200 of the more than 113,000 redeterminations the department has done have been appealed, Lipman said.

As of last month, nearly 55,330 of those reviewed for eligibility retained coverage, Lipman said. About 15,815 lost coverage because their income exceeded the limit. Nearly 6,235 voluntarily gave up Medicaid, knowing they did not qualify. About 4,000 no longer met one of the eligibility criteria, such as reaching 65 and qualifying for Medicare instead.

When the department terminates coverage, it attempts to connect those individuals with other subsidized insurance through the federal Marketplace, Lipman said.

The department is concerned about the nearly 26,170 people who have not responded to multiple notices warning them that they will lose Medicaid if they do not go through the eligibility redetermination process.

It recently launched a pilot program where federal officials make another attempt to reach those non-responders with the goal of continuing insurance assistance for those who qualify.

In addition, the department is partnering with the local chapter of the national Healthy Students, Promising Futures, which works with schools to expand access to Medicaid-funded school health services.

That can include behavioral health care, occupational and physical therapy, and vision services. Lipman said they've created a tool kit for school nurses in hopes they can help families access that care. The department is also working with the University of New Hampshire Institute for Health Policy and Practice to expand that outreach to after-school programs and plans to forge similar connections with school staff who work with homeless students and families.

"We keep on turning over stones to try to find new opportunities," Lipman said.

The New Hampshire Bulletin{/em} {em}is an independent, nonprofit news organization serving the Granite State.