End of COVID-19 emergency could lead thousands of Hoosiers to lose Medicaid coverage

The number of Hoosiers on Medicaid has increased by more than 50% since 2020. Now, for the first time in three years, beneficiaries will have to affirm their eligibility, a process that some fear will leave thousands without Medicaid coverage.

Some will lose coverage because their circumstances have changed and they no longer meet requirements for the benefit. Others, however, could wind up uninsured because of the return of redetermination, a process through which people on Medicaid must prove they remain eligible.

Prior to the pandemic, redetermination was an annual ritual for everyone covered by Medicaid. But during the past three years, the federal government prohibited states from kicking people off the Medicaid rolls in exchange for billions of dollars in aid as long as the public health emergency, which ended in early May, continued.

Meanwhile, thousands of people joined the state’s Medicaid rolls as their economic situations changed in the pandemic's wake. Many of these new enrollees have never gone through redetermination and may not understand the process, leading to confusion — and, some fear, potential loss of coverage.

"This issue has always existed. It’s just never existed at this type of a volume,” said Steve Smitherman, president of the Indiana market for CareSource Indiana, a managed health care plan which provides Medicaid coverage. “There are thousands of people who have not had to go through this process before, who aren’t familiar with how the process works, where they need to go…. Since I have been in the business, we have never had anything like this.”

Social service providers, insurers and the state’s Family and Social Services Administration are working to spread the word about the change — and they have more people to reach than ever before.

Still, a Kaiser Family Foundation survey published last week found that nearly half of Medicaid enrollees have never been through Medicaid renewal and nearly two-thirds were unsure as to whether that they could be unenrolled from the program. Additionally, one-third said they have not provided updated contact information to the state agency that oversees Medicaid.

A recent report from the advocacy group Hoosier Action found that one in three Medicaid recipients was unaware that they even need to go through redetermination at some point in the coming year.

How many people could lose coverage

In January of 2020, just before the pandemic hit, 1.49 million people in Indiana were on Medicaid, said Michele Holtkamp, director of FSSA’s office of communications and media. Currently that number is nearly 2.3 million or nearly one in three Hoosiers.

Nationally, anywhere between 8 to 24 million people could lose Medicaid coverage by next year at this time, a Kaiser Family Foundation study estimates.

State projections suggest that by May of next year, after a year’s cycle of redetermination, Medicaid membership may decrease in Indiana by as much as 400,000. Others fear that number could reach half a million.

Indiana officials estimate that in a year, about 1.8 million people — still far more than pre-pandemic numbers — will rely on Medicaid for health insurance.Nearly 47,000 Hoosiers who came up for renewal in April lost their Medicaid coverage for failure to respond, while about 65,000 were retained, according to state data. Another 39,600 or so people are still in the process of renewal and some of those will be automatically renewed.

By May an estimated 53,000 people in Indiana had been disenrolled, according to a Kaiser Family Foundation analysis. Nearly 90% of those lost their status for procedural reasons, not because they were deemed ineligible, the study found.

Several life changes can impact people’s Medicaid eligibility. An increase in income could make them ineligible while a decrease could ensure they keep the benefit for the next year. A new job might come with employer-provided insurance. Having an additional child could keep them eligible while having a child age-out would make them ineligible.

The prospect of what the future holds makes social service and insurance providers uneasy.

“There are so many different intricacies in what leads up to a member keeping their eligibility, that makes this concerning for us,” Smitherman said.

Getting the word out about redetermination

Because many people who rely on Medicaid may move frequently or switch phone numbers, advocates fear that many will not even realize they have lost coverage until they seek medical care and find they no longer have insurance.

Step one for people on Medicaid is making sure the state has their correct information so when they come up for redetermination, they will receive notices. Beneficiaries will then need to respond to the request for information, which can include questions about a person’s income and assets.

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For now, the process has just begun with the first roughly 10% of enrollees being asked to redetermine eligibility. The first batch of people came up for redetermination in April, so the earliest anyone could lose coverage was May 1.

“It’s going to take 90 days for us to really say where we’re going,” said Susan Jo Thomas, executive director of Covering Kids and Families of Indiana, an organization that helps people apply for healthcare. “I’m scared about all the people who live in chaos.”

Thomas praised the state’s efforts to spread the message, but said she worries that families who struggle to put food on the table may ignore messages about healthcare until they go to the doctor or fill a prescription.

That’s not stopping agencies from encouraging people to keep an eye out for the redetermination letter and go through the process when invited to do so.

FSSA is sending out mailers and leaving text and voice messages for beneficiaries. Community organizations such as the Indiana Rural Health Association and the Indiana Minority Health Association have joined the effort.

Many healthcare provider offices and recovery clinics have been encouraged to display flyers as well so no one is caught off guard. About 100 health navigators across the state will tell people about redetermination and offer assistance to those who need it.“We are also focusing on making sure that no one loses coverage simply because they didn’t know that they need to take action,” FSSA's Holtkamp said. “We don’t want folks who are still eligible for coverage to find themselves without simply because they didn’t respond.”

To help handle the influx of redetermination cases, the FSSA has hired about 300 additional staff members and increased its call center staff to handle questions, she said. In addition, if need be, because the state has an integrated eligibility system, FSSA may be able to find contact information for Medicaid members from other benefits programs such as SNAP or TANF.

CareSource has also hired four additional staff members to work with the state on redetermination. The company also has eight certified life coaches and nearly 50 CareSource management staff who work one-on-one with members and can talk about what they need to do to maintain eligibility.

What happens when you lose eligibility

Despite all these efforts, FSSA officials recognize some people will lose coverage without realizing it. If they learn that they have been cut off within 90 days of losing coverage, they can go through the redetermination process at that point, Holtkamp said. But if they discover they are no longer covered outside of that three-month window, they will have to start the application process anew.

Others may find their redetermination application turned down but want to appeal the denial. In such cases Indiana Legal Services can help.

The pro bono legal organization will assist people who appeal and want help if the state denies the redetermination application. Appeals could range from FSSA losing paper work to the state disputing whether a particular asset should be included or not.

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“This is an enormous undertaking for the FSSA so we’re not expecting it to go perfectly,” said Ann Smith, an attorney with the senior law project at Indiana Legal Services. “Our biggest concern is that people won’t understand what they’re receiving and won’t act on it because they don’t understand it.”

Some people on Medicaid in Indiana have the additional wrinkle of coverage through the state’s Healthy Indiana program, which requires some members to pay a monthly fee based on income. People who got on the plan during the pandemic have never had to pay this monthly fee.

For now, the state has not reinstituted the copayment. When that happens, the state will follow federal guidelines for doing so and allow “ample time” for communication, Holtkamp said.

Thomas said she worries that reinstituting payments, whenever that happens, will create additional confusion. By the time payments requirements resume next year, she said, some people getting billed will have been on the plan for four years without ever having to pay.

Thomas also said she’s concerned about what will happen later in the year to people who receive redetermination notices after the flurry of messaging about the change dies down. For now, it’s hard to know just how this will play out, she said.

“We have never done this before,” Thomas said. “We’re saying we’re returning to normal now, but we’re not really returning to normal. It’s going to be a mess.”

Contact IndyStar reporter Shari Rudavsky at shari.rudavsky@indystar.com. Follow her on Twitter @srudavsky.

This article originally appeared on Indianapolis Star: Medicaid redetermination process to start again after 3-year hiatus