Redetermination is a process each state has used since April 2023 when the Covid-19 Public Health Emergency ended to assess whether all adults and children enrolled in Medicaid during the pandemic should continue being covered. The process involves reviewing each enrollee’s income or assets (or family income and assets) are low enough to qualify. Those who do not meet the guidelines can be disenrolled. Another term for Medicaid redetermination after Covid-19 is the unwinding. States also use the term eligibility redetermination, renewal, case review and recertification.
States often use electronic resources (called an ex-parte review) to determine each enrollee’s eligibility without asking the individuals to provide additional information. Outside of ex-parte review, states send requests for more information, making it important for enrollees to respond or risk losing coverage.
In many states, the share of disenrollments for procedural or paperwork reasons remained high, amid growing concern over loss of Medicaid coverage for children, according to a KFF report, “Medicaid: What to Watch in 2024.” In December 2023, federal officials issued new data and guidance highlighting strategies to reduce procedural disenrollments for children, KFF added.
Some states have made extensive efforts to keep Medicaid-eligible adults and children enrolled but other states have not done as much. Since March 31, 2023, Medicaid enrollment declined by nearly 10% across all states, varying from a high of 32% in Idaho to 1% in Maine, KFF noted.
Before the unwinding in April 2023, Medicaid enrollment peaked at 94.5 million adults and children, an increase of 23 million (32%) from before the pandemic, KFF reported. As of the end of January 2024, states reported renewal outcomes for half of all enrollees, including 34% (32.1 million) who had coverage renewed and 17% (16.2 million) who were disenrolled, the report showed.
In December 2023, the federal Department of Health and Human Services (HHS) sent letters to nine states: Arkansas, Florida, Georgia, Idaho, Montana, New Hampshire, Ohio, South Dakota and Texas. Together, those states accounted for about 60% of the decline in children’s Medicaid and enrollment in the Children’s Health Insurance Program (CHIP) from March through September 2023, HHS added in this announcement.