Poorly Executed Medicaid Reviews Threaten Coverage for Millions, Experts Warn

A potential purge of up to 30 million of the poorest Americans from the Medicaid program looms as states grapple with error-ridden reviews, and experts argue that the Biden administration is not taking sufficient measures to address the issue.

Projections from the health consulting firm Avalere highlight the challenges arising from a comprehensive reevaluation of the 94 million people enrolled in Medicaid. Across the country, various issues have surfaced, including prolonged phone wait times in Florida, confusing government forms in Arkansas, and erroneous removal of children from coverage in Texas.

Legal Aid of Arkansas attorney Trevor Hawkins, who assisted individuals during Arkansas’ swift disenrollment of about 420,000 people, criticized the flawed process, indicating that the Centers for Medicare and Medicaid Services (CMS) did not address reported problems. Hawkins emphasized the need for transparency and accountability, stating, “Those should be major red flags. If there was a situation where CMS was to step in, it would have been Arkansas.”

Despite the Democratic-led Congress granting Health and Human Services Secretary Xavier Becerra the authority to penalize states or halt disenrollments, HHS has provided limited information about the problems uncovered. While CMS briefly paused disenrollments in 14 states, it did not disclose specific details about the states or the reasons behind the pause.

The situation has raised concerns among advocates who fear that systemic issues are being overlooked. A survey of problems encountered by advocates assisting the estimated 10 million people already dropped from Medicaid reveals widespread issues in the review process.

If current trends persist, up to 30 million people could potentially lose Medicaid coverage, according to Avalere’s projections. The numbers significantly surpass the Biden administration’s initial estimate of 15 million people losing coverage.

The majority of individuals have been removed for procedural reasons, such as failing to return renewal forms or provide necessary paperwork. This indicates broader problems with the determination of Medicaid eligibility, including issues with notifications reaching individuals, incomprehensible notices, and unnecessary paperwork requirements.

In Florida, Lily Mezquita, a working mom, faced multiple attempts to remove her from Medicaid during her pregnancy. Her ordeal included extensive phone calls with prolonged wait times and challenges in reinstating coverage. Similar issues have been reported in various states, including North Carolina and Texas.

The health consulting firm Avalere’s Massey Whorley commented on the Medicaid redeterminations, stating, “We have to say it’s going poorly. This has been characterized by much higher-than-expected disenrollment.”

While CMS has attempted to address issues and briefly paused disenrollments, concerns persist about the consumer-friendliness of the process. Experts suggest that it may be time to shift toward enforcement to ensure improved Medicaid enrollment processes across states.

Richard Shaw
Richard Shaw
Richard Shaw is a seasoned conservative news journalist based in New Orleans, Louisiana. With over 15 years of experience in the industry, Richard is known for his insightful reporting on national and international affairs, as well as his in-depth analysis of political and cultural issues.

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