Delaware Medicaid Unwinding

By Kathy Wild, RN, Project Manager, Quality Insights' Delaware
A Online Webinar Presented by Sussex County Health Coalition

• DOWNLOAD POWER POINT PRESENTATION

 

Federal Laws and Medicaid

• All State Medicaid agencies are required to regularly review Medicaid recipients’ eligibility (called ‘redetermination’ or ‘eligibility renewal’
• March 2020: COVID Public Health Emergency   (PHE) declared → States required to pause renewals to keep everyone covered during the PHE
• April 1, 2023 → States required to begin renewals
  • Must complete by July 2024
  • Process 1/9 total caseload each month

Medicaid Unwinding

• Unwinding = process by which State Medicaid agencies will resume annual Medicaid eligibility renewals
• Will result in ‘Medicaid transitions in coverage”
• DE Medicaid Unwinding Plan available on website
  https://dhss.delaware.gov/dhss/dmma/files/covid19_phe_unwind_20230220.pdf

DE Medicaid Population

• 315,000 people in DE have Medicaid
• State estimates 50,000 (16%) may lose coverage during unwinding period
  • May no longer meet eligibility criteria due to changes in household income, age, or other criteria
  • May lose coverage because individual does not return renewal form in a timely manner
• EVERYONE must have eligibility reviewed
• EVERYONE will receive at least one letter in the mail
• Individuals who have had Medicaid benefits the longest will be contacted FIRST (March 2020 enrollees) and those who enrolled recently will be contacted LAST (March 2023 enrollees)

Specific Medicaid Populations

Specific considerations for the following:

• Pregnant Women - Amendment pending with CMS to allow 12-month coverage
• People Living with Intellectual or Developmental Disability - No automatic closures of cases.
• Members Living in a Nursing Facility - No automatic closures of cases.
• Other Members Eligible for Long Term Care - No automatic closures of cases.

High Level Overview of Renewal Process

• The State will review data sources to check eligibility
• If unable to approve, will reach out to member and ask for information/documentation
• If documentation is provided:
  • And criteria is met→ benefits will continue for 1 year
  • And criteria is not met→ member’s Medicaid benefits will be terminated
• If documentation is NOT provided, member’s Medicaid benefits will be terminated

Ex Parte Review

• The State reviews multiple data sources, including financial information, and approves continuation of benefits if eligibility criteria is met
• The individual will receive a letter in the mail that benefits will continue for another 12 months

Need Additional Information

• Member is sent a RENEWAL letter  
  • RENEWAL form must be completed by the deadline included in the letter (30 days)
  • Can complete online by logging into ASSIST account or complete and sign paper form and mail, fax, or deliver in person
• 1st batch of letters were mailed on Thursday, April 14 to 9,000 members
• Information needed to complete renewal form includes:
  • Members of household
  • Monthly gross income and source
  • Tax filing status
  • Tax deductions

Renewal Form

• Member completes RENEWAL form:
  • Information justifies eligibility & coverage will continue for another year.  Approval letter will be sent in the mail OR
  • Information does not meet eligibility criteria & benefits will be terminated
• Member does not complete RENEWAL form:
  • Medicaid benefits terminated

Medicaid Terminations

• Denial due to failure to complete and return RENEWAL form may result in loss of Medicaid benefits (procedural denial)
  • Note: The State will allow a few additional days after deadline before making a negative determination
  • Possible reasons RENEWAL form not returned:
    • Individual moved and didn’t receive letter
    • Individual has limited English proficiency or disability and many not understand letter
• Denial due to not meeting eligibility criteria

What is CMS Doing to Help Individuals Get Coverage?

• Maximizing process to promote continuity of coverage
• Mailing a letter to individuals who lose Medicaid coverage to encourage them to enroll in a Marketplace plan  
• Implementing a direct consumer outreach program utilizing the 2 Navigator grantee awardee organizations in DE Quality Insights and Westside Family Healthcare to contact individuals who are terminated from Medicaid and don’t enroll in a Marketplace plan within “30” days of losing coverage

What will Navigators Do?

• Help those dis-enrolled from Medicaid enroll in health insurance coverage through the federal Marketplace (Obamacare) or an employer sponsored plan
• 4 of 5 people will pay less than $10/month for a qualified plan
• Many will qualify for reductions that result in no monthly cost
• 3 carriers for 2023 plans: Highmark Blue Cross Blue Shield, AmeriHealth Caritas, and Aetna CVS Health

What Can You Do to Help?

• Encourage members to update contact information with the State
• Report name, address, phone number, email changes by:
  • Calling the Change Report Center at 302-571-4900, Option 2
  • Fax form to 302-571-4901
  • Login to Delaware ASSIST Account.

Rack Cards

Available to distribute to your clients, members, etc

Questions?

Kathy Wild kwild@qualityinsights.org

This project is supported by the Centers for Medicare and Medicaid Services (CMS) of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $881,770.00 with 100 percent funded by CMS/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by CMS/HHS, or the U.S. Government. Pub # NAV-042523