Halfway through unwinding, 15% of Virginia Medicaid enrollees have lost coverage

Halfway through Virginia’s review of whether millions of Medicaid enrollees are still eligible for coverage after the pandemic, nearly 160,000 Virginians have lost coverage — roughly 15% of the over 1 million members whose cases have been reviewed so far.

For the past three years, anyone who was enrolled in Medicaid was allowed to keep their coverage regardless of whether or not they still met eligibility requirements like income level. Now that the COVID-19 federal public health emergency is over, the Department of Medical Assistance Services is carrying out a redetermination — or “unwinding” — process to decide which members no longer qualify.

DMAS Director Cheryl Roberts and Deputy of Administration Sarah Hatton told the House Appropriations Committee this week that there are three main reasons why enrollees are losing coverage: They have gotten access to insurance or higher income through a new job, they have transitioned to coverage through the federal marketplace or they have encountered procedural problems like not responding or submitting renewal packets to the state on time.

DMAS’ eligibility redetermination tracker indicates that 32% of people who have lost coverage in Virginia as of October lost it for procedural reasons rather than ineligibility.

Even though DMAS and the Department of Social Services have been planning for Medicaid redetermination since 2020, Roberts admitted Monday the process has been a learning curve, especially when coupled with the state’s Medicaid expansion in 2019.

“Most members had never went through a redetermination, and also because we had turnover at the localities, most workers had never done a redetermination,” Roberts said.

Hatton told the Mercury DMAS is working to reduce the amount of procedural terminations by coordinating with the health plans that call, text, email and send letters to enrollees two months before their renewal is due. Health plans also try to touch base with enrollees during a 90-day grace period following their coverage termination.

DMAS Public Relations Coordinator Mary Olivia Rentner told the Mercury enrollees can fill out the renewal packet on their CommonHelp account online.

Additionally, Hatton said enrollees can call Cover VA to complete their renewal over the phone and check its status. Enrollees can also check their status by calling their local Department of Social Services. The department launched outreach campaigns a year before redetermination started to remind members to update their address and contact information, she noted.

“Across the country that’s one of the biggest concerns, is that we don’t know where folks are anymore,” Hatton said.

Hatton admitted there have been cases of mail delays where enrollees didn’t receive their renewal packets on time to submit them before their coverage ended. She also said she has heard of instances in which enrollees found out they no longer had coverage at a doctor’s appointment.

“For those individuals that are encountering that, call Cover VA,” Hatton said. “We can put them back, and we can even do coverage retroactive three months.”

The retroactive coverage — permitted in Virginia through a federal waiver — only applies to those who are still eligible for Medicaid.

There is also an escalation route to get quick assistance to people who need critical care like chemotherapy but weren’t aware their coverage ended, Hatton said.

Hatton said enrollees looking to check their redetermination date can call Cover VA or their provider. Enrollees are currently unable to check the date on their CommonHelp account online, as Hatton said the system is undergoing upgrades to make it more user friendly.

“It is the best practice for enrollees to call Cover VA to check their redetermination date,” Rentner said. “The state partnered with Medicaid providers to give them access to the redetermination date should a member ask for that information.”

Roberts emphasized that any member who has questions or needs assistance should call Cover VA.

Cover VA’s website is https://coverva.dmas.virginia.gov/ and phone number is 1-855-242-8282 (TTY: 1-888-221-1590) and language assistance services are available free of charge.

Photo via Online Marketing/Unsplash. This article was reported and written by the Virginia Mercury, and has been reprinted with permission.