Concerns Raised Over Improper Disenrollment in Medicaid Redetermination Process


In a joint letter addressed to Health and Human Services (HHS) Secretary Xavier Becerra and Centers for Medicare & Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure, Senate Finance Committee Chairman Ron Wyden and House Energy and Commerce Committee Ranking Member Frank Pallone, Jr. expressed their apprehension regarding the actions of certain Republican-led states during the Medicaid eligibility redetermination process. The lawmakers highlighted concerns about the reported disenrollment of hundreds of thousands of individuals for procedural reasons, rather than due to a lack of eligibility. The issue is particularly troubling as a significant number of those affected are children, including newborns.


During the COVID-19 pandemic, Congress enacted measures to protect low-income families’ access to healthcare by prohibiting states from disenrolling individuals from Medicaid for the duration of the public health emergency. This provision led to a historic drop in the uninsured rate and ensured that tens of millions of Americans could access essential healthcare services. In 2022, Congress passed the Consolidated Appropriations Act, 2023, which allocated resources and tools to states and CMS to resume redeterminations for the more than 80 million Medicaid beneficiaries currently enrolled.

The Call for Timely Enforcement Action

Wyden and Pallone commended CMS for its swift action in monitoring state unwinding efforts and its commitment to safeguarding coverage for eligible individuals. However, they emphasized the need for CMS to take timely enforcement action to prevent improper terminations and protect vulnerable populations. The lawmakers pointed out several beneficiary protections outlined in the Consolidated Appropriations Act, 2023 that states must adhere to in order to continue receiving enhanced funding.

These protections include maintaining current eligibility standards through 2023, conducting Medicaid eligibility redeterminations in compliance with federal requirements, ensuring up-to-date contact information for beneficiaries before redetermination, and making a good-faith effort to contact individuals using multiple modalities before terminating their enrollment based on returned mail. The law also grants CMS additional enforcement tools, such as implementing corrective action plans, imposing financial penalties, and requiring states to temporarily halt disenrollments for procedural reasons.

Concerns and Challenges Faced

Reports from some states led by Republican administrations indicate that beneficiaries are encountering bureaucratic obstacles and confusion during the redetermination process. One distressing account describes a family with a five-year-old child battling cancer, spending hours on the phone with Florida’s Medicaid agency to ascertain whether their son had lost coverage.

Data from Arkansas reveals that the rapid pace of redeterminations has resulted in many individuals falling through the cracks. Within the first month alone, Arkansas reported that 72,802 beneficiaries lost Medicaid coverage, with 40 percent of them being children and 72 percent losing coverage due to procedural reasons.

Similarly, Florida witnessed over half of the individuals whose eligibility was assessed being terminated, amounting to a staggering 250,000 individuals in the first month of redeterminations. More than 80 percent of these terminations were attributed to procedural reasons, and considering that Florida has not expanded Medicaid to adults, it is likely that the majority affected are children and parents.

Calls for Immediate Action

Wyden and Pallone urged HHS and CMS to utilize the additional enforcement tools at their disposal to prevent further coverage losses among eligible children and adults in states like Florida and Arkansas. The lawmakers stressed the importance of swift action to ensure states’ compliance with federal law and protect vulnerable populations from improper disenrollment.

Conclusion The concerns raised by Chairman Wyden and Ranking Member Pallone shed light on the potential mishandling of the Medicaid eligibility redetermination process in certain Republican-led states. With reports indicating procedural disenrollments of hundreds of thousands of individuals, particularly children, it is imperative for CMS to act promptly and employ the enforcement measures outlined in the Consolidated Appropriations Act, 2023. By doing so, CMS can ensure that eligible individuals maintain their access to vital healthcare services and prevent further confusion and hardship during the redetermination process.

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