Rep. Grijalva Urges AHCCCS to Pause Medicaid and KidsCare Procedural Disenrollments as Nearly 150,000 in AZ Lose Health Coverage

TUCSON, Arizona, June 17 -- Rep. Raul Grijalva, D-Arizona, issued the following news release and letter on June 16, 2023:

Today, following data that shows that nearly 150,000 Arizonans have lost Medicaid and KidsCare coverage as a result of the end of the COVID-19 public health emergency through its unwinding process, Rep. Grijalva wrote to Arizona Health Care Cost Containment System (AHCCCS) Director Carmen Heredia urging additional action to ensure individuals are not losing health coverage due to procedural reasons.

Rep. Grijalva also encouraged Director Heredia to exercise existing federal authority from the recently released Center for Medicare and Medicaid Services (CMS) Strategies to Prevent Procedural Terminations which includes the ability to delay procedural terminations for beneficiaries for at least one month while the state conducts targeted renewal outreach.

"I am writing regarding Arizona's Medicaid and Children's Health Insurance Program (KidsCare) unwinding progress and to encourage you to modify and adopt additional strategies to ensure individuals are not losing health coverage simply because of procedural reasons," wrote Rep. Grijalva. "I am concerned with this rapid rate of coverage loss and the ability of our health care system to absorb an influx of uncompensated care. While I understand some individuals may be reinstated or be eligible for coverage elsewhere, I ask you consider the following improvements to your unwinding process:

1. Act swiftly to extend the 30-day response period. 30 days is the minimum response time required by law and Arizona can easily expand this timeframe to help maximize responses.

2. Couple an extended response time with follow-ups notices for any non-responses. Multiple notices with appropriate time to respond can help capture incorrect addresses and compel individuals to return renewals.

3. Improve labeling on notices. Renewal notices should have appropriate labeling to distinguish them from nonurgent mail. A red stamp or print could increase open rates.

4. Renew eligibility on an ex parte basis based on financial findings from Supplemental Nutrition Assistance Program and Temporary Assistance to Needy Families programs.

5. Renew eligibility on an ex parte basis for individuals with incomes at or below 100% of Federal Poverty Level and no data returned.

6. Further coordinate with managed care plans by sending lists for individuals at risk of losing coverage and asking them to follow up with individuals that have been procedurally removed and may be eligible for the 90-day reinstatement period.

7. Work with pharmacies so that they may provide appropriate notifications and connection to health assisters for disenrolled individuals, as they may learn of their coverage loss when they go to pick up prescriptions.

8. Continue to leverage healthy Arizona partners in community by conducting regularly scheduled calls and collecting real-time feedback.

9. Work with stakeholders to make sure they are getting all available data they need so they can better target and adjust their outreach immediately."

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June 16, 2023

To: Carmen Heredia, Director, Arizona Health Care Cost Containment System, 801 E Jefferson St., Phoenix, AZ 85034

Dear Director Heredia,

I am writing regarding Arizona's Medicaid and Children's Health Insurance Program (KidsCare) unwinding progress and to encourage you to modify and adopt additional strategies to ensure individuals are not losing health coverage simply because of procedural reasons. I appreciate your work and leadership through this transition and your previous timely responses.

According to the Arizona Health Care Cost Containment System (AHCCCS) Eligibility Dashboard, 148,637 individuals in Arizona have been disenrolled from Medicaid and KidsCare from April 1, 2023 to June 6, 2023. I am concerned with this rapid rate of coverage loss and the ability of our health care system to absorb an influx of uncompensated care. While I understand some individuals may be reinstated or be eligible for coverage elsewhere, I ask you consider the following improvements to your unwinding process:

1. Act swiftly to extend the 30-day response period. 30 days is the minimum response time required by law and Arizona can easily expand this timeframe to help maximize responses.

2. Couple an extended response time with follow-ups notices for any non-responses. Multiple notices with appropriate time to respond can help capture incorrect addresses and compel individuals to return renewals.

3. Improve labeling on notices. Renewal notices should have appropriate labeling to distinguish them from nonurgent mail. A red stamp or print could increase open rates.

4. Renew eligibility on an ex parte basis based on financial findings from Supplemental Nutrition Assistance Program and Temporary Assistance to Needy Families programs.

5. Renew eligibility on an ex parte basis for individuals with incomes at or below 100% of Federal Poverty Level and no data returned.

6. Further coordinate with managed care plans by sending lists for individuals at risk of losing coverage and asking them to follow up with individuals that have been procedurally removed and may be eligible for the 90-day reinstatement period.

7. Work with pharmacies so that they may provide appropriate notifications and connection to health assisters for disenrolled individuals, as they may learn of their coverage loss when they go to pick up prescriptions.

8. Continue to leverage healthy Arizona partners in community by conducting regularly scheduled calls and collecting real-time feedback.

9. Work with stakeholders to make sure they are getting all available data they need so they can better target and adjust their outreach immediately.

The Center for Medicare and Medicaid Services (CMS) has fuller list of newly released Strategies to Prevent Procedural Terminations that AHCCCS should evaluate and consider implementing. Given the very high rate of procedural disenrollments, which your most recent reporting shows at 78%, it may be necessary to delay this termination process while you work through improvements and better target outreach. CMS has confirmed there is existing federal authority to implement such a delay.

These modifications can make the difference between someone being able to access health care or not and will reduce administrative burdens associated with unnecessary procedural removals and reenrollment. Thank you for your consideration of these requests, and your dedication to ensuring Arizonans have access to the health coverage they need.

Sincerely,

Raul M. Grijalva, Member of Congress

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Original text here: https://grijalva.house.gov/rep-grijalva-urges-ahcccs-to-pause-medicaid-and-kidscare-procedural-disenrollments-as-nearly-150000-in-az-lose-health-coverage/