Seven months into a federally mandated audit of its Medicaid rolls, New Jersey has removed at least 1 in 5 of reviewed participants from the public health insurance program.
The state Department of Human Services, which oversees Medicaid, reported that by the end of November it had identified some 296,000 people who no longer met the program requirements or declined to participate in the renewal process, prompting the state to end their coverage. State officials have launched reviews into nearly 1.3 million Medicaid members since the process began here in May. Roughly 480,000 have been reenrolled, about 37%, and the rest are still pending review, according to the latest monthly report made public Monday.
Credit: (NJ DHS)Department of Human Services Assistant Commissioner Jennifer Langer Jacobs, the state Medicaid director, said the process also led them to develop tools, like text alerts, that can help smooth the reenrollment process in the future. The hope is to reduce “churn” — or members cycling in and out of the program as their income changes over time — a common challenge for Medicaid programs nationwide.
“We want to reduce disruptions in care,” Jacobs said. “We want people to get covered and stay covered.” (That’s why the NJ Family Care website dedicated to this process was named Stay Covered, she added.)
Health care advocates have raised concerns about the potential fallout from this so-called unwinding process, which they warn will have an outsize impact on low-income groups that can least afford to go without insurance coverage. New Jersey officials said it has been nearly impossible to track what happens to people cut from the Medicaid program, but some have likely benefited from employee-sponsored programs through work or been able to purchase a low-cost plan on the state’s Affordable Care Act health insurance exchange.
NJ Family Care, the state’s Medicaid program, covered nearly 2.3 million low-income and disabled residents when the review, or unwinding, started last spring. The program had grown nearly 35% since before the COVID-19 pandemic, as people lost income and employee benefits.
Credit: (NJ DHS)Given the pandemic’s challenges, the federal government halted states’ regular policing of their Medicaid rolls in March 2020 in an effort to protect low-income Americans during the crisis. That policy ended when the federal health emergency was lifted in the spring, requiring states to launch a year-long review process to ensure those in the program met all eligibility requirements.
The big picture
Nationwide, some 33% of Medicaid members who have gone through the unwinding review have lost coverage, while 67% still qualify for benefits, according to tracking by the nonprofit research group Kaiser Family Foundation. At least 7 out of 10 were cut for procedural reasons, meaning they did not respond or did not provide proper documentation.
But the impact of the process varies significantly by state, with New Jersey falling somewhere in the middle. In Texas, 61% of participants — or 1.8 million people — were culled from the program, Kaiser found, compared with just 13% in Maine, or fewer than 30,000. In all, more than 15 million Americans have lost coverage.
Laura Waddell, the health care program director for New Jersey Citizen Action, a nonprofit that has worked with the state to boost Medicaid participation, said she continued to be concerned not just about the growing number of people losing coverage, but the reasons for those terminations. In New Jersey, 77% of those disenrolled are for procedural reasons, she said, higher than the national average.
‘We’ve been seeing that people don’t know what their rights are. We need to work together to keep people from losing coverage unnecessarily.’ — Laura Waddell, New Jersey Citizen Action
“We all must do a better job reaching this population and that begins with more transparency into where these populations are so we can better focus our outreach efforts to educate those communities on the process and provide renewal application assistance where needed, in order to help slow the churn and keep people from experiencing a gap in coverage,” Waddell said, noting that Citizen Action recently hosted a webinar to help explain the process. “We’ve been seeing that people don’t know what their rights are. We need to work together to keep people from losing coverage unnecessarily,” she said.
Data from the state’s Stay Covered call center — set up to help Family Care participants with questions about the unwinding process — suggests the message may now be getting out. November’s report shows call volume had continued to rise over the fall, peaking in October when 168,000 people contacted the switchboard. Wait time and hold time have also increased over that period, something Jacobs said the state has since tried to address with additional staff.
The release of November’s report was delayed by some data questions, Jacobs said, but the monthly update for December should be made public soon.
