June 09,2023

Wyden and Pallone urge CMS to Protect Health Care Coverage During Medicaid Redetermination Process

“We are troubled by early reports that suggest that some states in the first month of redeterminations have disenrolled hundreds of thousands of individuals for procedural reasons, rather than because they were found to be no longer eligible.”

Washington, D.C. Senate Finance Committee Chairman Ron Wyden, D-Ore., and House Energy and Commerce Committee Ranking Member Frank Pallone, Jr., D-N.J., wrote to Health and Human Services (HHS) Secretary Xavier Becerra and Centers for Medicare & Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure today raising concerns regarding the actions of certain Republican-led states to improperly take away health care coverage from residents during the Medicaid eligibility redetermination process. 

“We are writing today to raise our concerns about the state of Medicaid eligibility redeterminations and implications for the unwinding of the Medicaid continuous enrollment provision,” Wyden and Pallone wrote. “We are troubled by early reports that suggest that some states in the first month of redeterminations have disenrolled hundreds of thousands of individuals for procedural reasons, rather than because they were found to be no longer eligible. We are equally troubled that many of those individuals who have lost coverage are children, including newborns.”  

During the COVID-19 pandemic, Congress acted quickly to ensure that low-income families maintained their health insurance by requiring that states not disenroll anyone from Medicaid for the duration of the public health emergency. As a result of this requirement, the nation’s uninsured rate dropped to the lowest level in its history and tens of millions of Americans were able to access health care during the pandemic. In 2022, Congress passed the Consolidated Appropriations Act, 2023, which provided states and CMS with the resources and tools necessary to resume redeterminations for the more than 80 million Medicaid beneficiaries currently enrolled.  

“We appreciate [CMS] for taking swift action to monitor state unwinding efforts and strong intention to protect coverage among eligible people,” Wyden and Pallone continued. “We urge CMS to take timely enforcement action to prevent improper terminations and take other appropriate actions.” 

Wyden and Pallone pointed to a number of beneficiary protections included in the Consolidated Appropriations Act, 2023 that states must comply with in order to continue to receive enhanced funding, including: 

  1. maintaining current eligibility standards through 2023, 
  2. conducting Medicaid eligibility redeterminations in accordance with all applicable federal requirements, 
  3. attempting to ensure they have up-to-date contact information for a beneficiary before redetermining their eligibility, and
  4. undertaking a good-faith effort to contact an individual using more than one modality prior to terminating their enrollment on the basis of returned mail.

The law also empowers CMS with additional enforcement tools to ensure that states are not improperly removing Medicaid beneficiaries, including requiring a state to implement a corrective action plan, imposing financial penalties, and requiring states to pause disenrollments on procedural grounds.  

“These additional tools give CMS the means to ensure states are held accountable for complying with federal law, and step in to protect vulnerable populations from being improperly disenrolled from Medicaid,” Wyden and Pallone wrote. “We urge you to move swiftly to use these tools to prevent more coverage losses among eligible children and adults in Florida, Arkansas and other states.”  

Early evidence from some states led by Republican administrations suggests that beneficiaries are experiencing red tape and confusion during the redetermination process. One report described a family of a five-year-old with cancer spending hours on the phone with Florida’s Medicaid agency to determine if their son had lost coverage.  

Data from Arkansas suggests that the speed with which the state is moving through redeterminations has caused many to fall through the cracks. In just the first month, Arkansas reported 72,802 beneficiaries had lost Medicaid coverage – 40 percent of whom were children and 72 percent of whom lost Medicaid coverage for procedural reasons.  

In the first month of redeterminations in Florida, over half of people whose eligibility was checked were terminated – a staggering 250,000 individuals. Over 80 percent of these terminations were for procedural reasons and most are likely to be children and parents given that Florida has not expanded Medicaid to adults.  

As part of their letter to HHS and CMS, Wyden and Pallone also requested documentation and answers to a series of questions. 

Read the full letter HERE