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Medicaid coverage restored for about half a million people after computer errors

JEFFERSON CITY, MO — About 500,000 people who recently lost Medicaid coverage are getting their health insurance back as states work to fix computer systems that weren’t properly assessing people’s eligibility after the coronavirus pandemic ended, people said Thursday. federal officials.

The computer problems affected people in 29 states and the District of Columbia and likely included a significant number of children who should have been eligible for Medicaid at higher income levels even if their parents or guardians were not, according to the federal Centers for Medicare and Medicaid. Services.

All states are undertaking a massive overhaul of their Medicaid rolls after a three-year, pandemic-era ban on ending coverage expired this spring. While the freeze was in effect, Medicaid enrollment increased by nearly a third, from 71 million people in February 2020 to 94 million in April 2023.

States often use computer programs as a first step in determining whether people should be automatically re-enrolled in Medicaid. If their eligibility is unclear, states then attempt to contact individuals by mail, phone, text or email for additional information. If that doesn’t work, people are removed from the rolls in what CMS describes as a “procedural termination.”

In late August, CMS warned that some state computer systems were flagging entire households for additional information — and removing all family members when no one responded — instead of reviewing each individual separately and automatically renewing the children who remain eligible. She sent letters to all states asking them to verify their compliance with federal rules.

For states in violation, federal authorities required them to retroactively reinstate Medicaid coverage for affected individuals and halt proceedings until their systems were repaired.

Some state Medicaid directors said Thursday they were unaware they had done things incorrectly.

“It was never clear whether this was against the rule or regulation, because if it was, we would have done it differently a long time ago,” said Cindy Beane, commissioner of the Virginia Bureau of Medical Services Western and president of the National Association of Medicaid Directors.

Fewer than 5,500 children have been affected by the problem in West Virginia and are having their coverage restored, she said.

The impact was greater in New York. About 70,000 people, including about 41,000 children, were inappropriately excluded from Medicaid in June, July and August due to automation problems and will have their coverage reinstated for an additional 12 months, starting Friday, the government said. Director of Medicaid in New York, Amir Bassiri.

He said state officials will manually review the eligibility of individuals within households until contractors can create a permanent solution early next year.

Officials in Nevada and Pennsylvania estimated that more than 100,000 people may have lost coverage due to gaps in their automated renewal systems, according to data released by CMS.

But no more than a few thousand people have been affected in Nebraska, Medicaid Director Kevin Bagley said. And only about 4,800 people — none of whom were children — were affected in Massachusetts, said that state’s Medicaid director, Mike Levine. Both nevertheless expressed frustration that federal officials had not highlighted the requirement sooner.

“I would have loved to have learned this a year ago,” Levine said. “But either way, we’re learning now and moving forward. It’ll just be another improvement to our process.

Automated eligibility systems vary by state and can be technically difficult and expensive to change, said Kate McEvoy, executive director of the National Association of Medicaid Directors.

Some states plan to complete system improvements before the end of September while others anticipate it will take several months, said Daniel Tsai, director of the CMS Center for Medicaid and Children’s Health Insurance Program Services.

More than 7 million people have been excluded from Medicaid since pandemic-related protections ended, according to the health policy nonprofit KFF. Some states have been more aggressive than others in terminating coverage for those who do not respond to renewal notices.

“There are states that are approaching Medicaid roles with the idea that ‘the rules are the rules, and consumers must bear the burden of following the rules,'” said David Adkins, executive director of the Council of State Governments. “We see this as a good thing for consumers with health care, so we should try to figure out how to find ways to keep people who are actually qualified on Medicaid.”

ABC News

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