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Medicaid

91影视 dropped Medicaid enrollees as red states have, alarming advocates for the poor

91影视 defended its high Medicaid disenrollment rates after COVID by saying that what goes up must come down. Advocates and researchers disagree.

Rae Ellen Bichell
KFF Health News

91影视 stands out among the 10 states that have dropped the highest share of Medicaid enrollees since the 91影视 government lifted a pandemic-era restriction on removing people from the health insurance program.

It鈥檚 the only blue state in a cluster of red states with high withdrawal rates 鈥 a group that includes Idaho, Montana, Texas, and Utah 鈥 in the Medicaid "unwinding" underway since spring 2023.

91影视 also is the only state that had all the in place to cushion the fallout from the unwinding, according to Medicaid policy analysts at KFF, an independent nonprofit that conducts health policy research.

But it seems the cushion hasn鈥檛 been deployed.

鈥淭here鈥檚 really a divide in 91影视 between our progressive policies and our underfunded and fragmented administration,鈥 said Bethany Pray, chief legal and policy officer at the 91影视 Center on Law and Policy, a Denver-based legal aid group.

According to , during the unwinding 91影视 has seen a bigger net drop in enrollment in Medicaid and the Children鈥檚 Health Insurance Program than any state except Utah.

Advocates for health care access, researchers, and county administrators 鈥 the administrators handling the bulk of the Medicaid redeterminations in 91影视 鈥 say that the major issues involve outdated technology and low rates of automatic renewals. Both create obstacles to enrollment that undercut the state鈥檚 progressive policies.

91影视 is the only blue state in a cluster of red states with high Medicaid disenrollment rates.

State officials have a rosier view. They say the drop in enrollment is a sign that they did a good job enrolling people at the height of the COVID-19 pandemic. Secondly, they say 91影视鈥檚 economy is doing well, so more people can get insurance through their jobs.

鈥淲hen we have a really stellar unemployment rate, not as many people need safety-net programs, and we鈥檙e proud of that. Our people are rising and thriving,鈥 said , who leads the Department of Health Care Policy and Financing and is the state鈥檚 top Medicaid official. Her department has also said that some people choose not to fill out their eligibility paperwork because they know their incomes are too high to qualify.

that while it鈥檚 true 91影视鈥檚 unemployment rate is lower than the nation鈥檚 as a whole, it鈥檚 higher than it was before the pandemic.

State officials say they believe Medicaid enrollments dropped because many of those people found jobs, as reflected by the lower unemployment rates. But that scenario happened in fewer than half of the state鈥檚 counties, a KFF Health News analysis found. Notably, in 11 counties where unemployment stagnated or increased from January 2020 to April 2024, the share of the population covered by Medicaid shrank. A low unemployment rate does not necessarily mean there is less of a need for Medicaid coverage because many employed people earn wages low enough to still .

91影视 increased enrollment in Medicaid and the related Children鈥檚 Health Insurance Program by 35% during the COVID-19 public health emergency, compared with about 30% nationally and among Medicaid expansion states.

鈥淲e grew more, which means, logically, we鈥檙e going to disenroll more,鈥 said Bimestefer.鈥淲e went up higher, we鈥檙e going to come down lower because our economy is stellar.鈥

Her initially claimed 91影视鈥檚 Medicaid enrollment grew more than any other Medicaid expansion state except Hawaii. But pandemic enrollment growth in other states, including Indiana, North Dakota, Virginia, and Nevada, also exceeded that of 91影视.

Even if it had grown the most, the argument that what comes up must come down doesn鈥檛 hold water, Medicaid policy analysts said.

鈥淎 counterargument to that is we know that there was never a full participation in Medicaid prior to the pandemic,鈥 said Jennifer Tolbert, deputy director of the KFF Program on Medicaid and the Uninsured.

Tolbert said she was surprised by the extent of 91影视鈥檚 Medicaid enrollment losses, given it was the one state in the nation that met all the criteria that KFF expected would cushion the effects of the unwinding. Those policies include adopting the Affordable Care Act鈥檚 Medicaid expansion and the automatic processing of renewals.

Tolbert was among several policy researchers who said that even if unemployment returned to pre-pandemic levels, they would expect a higher, not lower, share of Coloradans to be enrolled in safety-net coverage.

Ally Sullivan, a spokesperson for Gov. Jared Polis, a Democrat, said one complicating factor in 91影视鈥檚 system is that it鈥檚 among the handful of states where most of the eligibility verification work falls on counties, 鈥渨hich added complexity to the state鈥檚 unwind process.鈥

鈥91影视 is committed to ensuring that Coloradans who no longer qualify for Medicaid coverage are connected to other affordable sources of coverage as soon as possible, and the state is going to great lengths to do so,鈥 the statement said.

Minnesota is another state where verifying eligibility is largely left to the counties. Yet just 26% of its Medicaid population dropped enrollment in the unwinding, compared with 91影视鈥檚 48%. Like 91影视, Minnesota is led by a Democratic governor. Minnesota also mirrors 91影视 in its population, pandemic-era increase in enrollment, the percentage of its residents living in prosperous areas, and its better-than-national unemployment rate. But Bimestefer dismissed any comparison.

鈥淚 don鈥檛 care about Minnesota,鈥 Bimestefer said. 鈥淭his is 91影视. I don鈥檛 care what Minnesota did.鈥

Advocates for health care access and researchers said a cluster of technological and administrative issues have contributed to 91影视鈥檚 high withdrawal rate.

First, 91影视鈥檚 eligibility database, the 91影视 Benefits Management System, is outdated and clunky, according to people who use it or are familiar with systems in other states.

鈥淚t鈥檚 like still using the old flip phone where you鈥檙e trying to play Snake,鈥 said Sarah Grusin, an attorney at the National Health Law Program. 鈥淲e have better stuff.鈥

Grusin and Pray鈥檚 organizations with several federal agencies saying that the system issues that terminated disabled Coloradans鈥 coverage amounted to discrimination.

鈥淚t took many months to fix something that doesn鈥檛 sound that complicated,鈥 Pray said.

Bimestefer said her department is working on a plan to improve the system, which is managed by Deloitte under a $354.4 million contract that lasts until 2027. of eligibility systems managed by Deloitte found widespread problems. In 91影视, a in 2020 found that many Medicaid beneficiaries were sent incorrect notices and deadlines.

Kenneth Smith, a Deloitte executive who leads its national human services division, said that Deloitte is one player among many who together administer Medicaid benefits and that the states own the technology and make the decisions about their implementation.

91影视鈥檚 technology woes have also weakened its ability to use a powerful tool in enrollment: automatic renewal.

Last fall, Bimestefer said, her agency had to choose between fixing the system so that it would stop dropping children who shouldn鈥檛 lose coverage, or start automatically renewing people with no income or with income below the federal poverty level. It couldn鈥檛 do both, she said.

Experts such as Tricia Brooks, a research professor with the Center for Children and Families at Georgetown University, said it鈥檚 especially important to increase automatic renewals in states like 91影视 where most of the renewal work falls on county government staff.

鈥淲hat happens when you鈥檙e not getting a high rate of automated renewals? You鈥檙e sending out those renewal forms,鈥 Brooks said 鈥 meaning more disenrollments. 鈥淭hey didn鈥檛 get the mail. The notice was confusing. They tried to get help through the call center. The list goes on as to why people don鈥檛 renew.鈥

Indeed, two-thirds of Coloradans who withdrew lost coverage for procedural reasons. That鈥檚 in line with the national average, according to KFF. But paired with 91影视 having withdrawn so many people overall, that means more than , or about 9% of the state鈥檚 people, were withdrawn for procedural reasons 鈥 more than the population of its second-largest city, 91影视 Springs.

At least a third of those disenrolled were later determined to be eligible for Medicaid.

Officials at 91影视 community health centers and mental health centers say they鈥檙e seeing a rise in uninsured patients coming through their doors 鈥 a sign, they say, that Coloradans dropped from Medicaid aren鈥檛 necessarily moving on to greener health insurance pastures.

Fifty-eight percent of those who were dropped coverage have returned to Medicaid, or now have another form of insurance. However, the state doesn鈥檛 yet know what happened to the remaining 42% of people who were dropped and said it would conduct a survey to find out.

is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at 鈥 an independent source for health policy research, polling, and journalism.

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