How health IT can prevent Medicaid waiver program churn for qualifying beneficiaries.
For nearly three years, Medicaid agencies took on unprecedented numbers of program beneficiaries in need of coverage and services. And, with the introduction of the continuous enrollment provision from the federal government, from Spring 2020 until April 1, 2023, Medicaid agencies could not disenroll program members, despite potential changes in income or circumstance. According to some estimates, during this time Medicaid enrollment nationwide reached more than 90 million.
The COVID-19-era continuous enrollment provision protected millions of individuals from losing access to coverage and acted as a churn preventer. Churn refers to instances when Medicaid participants lose access to benefits and then must be re-enrolled a short time after. Intermittent coverage can occur for a host of reasons, including short-term changes in eligibility or administrative backlogs that prevent timely processing of re-enrollments.
According to the Kaiser Family Foundation (KFF), more than 8.6 million people were disenrolled from Medicaid between April and October 2023, the months immediately following when Medicaid disenrollments could resume. KFF estimates 72 percent of those individuals lost coverage for procedural reasons.
“High procedural disenrollment rates are concerning because many people who are disenrolled for paperwork reasons may still be eligible for Medicaid coverage,” according to KFF. “Some states have temporarily paused procedural terminations for some enrollees while they address problems in the renewal process that lead to increased procedural disenrollments.”
Preventing churn has been an ongoing battle for Medicaid agencies and the impact of the COVID-19 pandemic will be felt for a long time.