Medicaid Redetermination Process Leaves 43,000 West Virginians Lose Medicaid Coverage

West Virginia has recently seen a significant decline in its Medicaid enrollment due to the Medicaid redetermination process, with the number of enrollees dropping from a high of 667,000 in April to just over 619,000 in June.

In the case of West Virginia, approximately 43,000 individuals have lost their coverage due to the Medicaid redetermination process. (Photo: Youtube)

Medicaid Redetermination Process Affects 43K

This decline can be attributed to the Medicaid redetermination process that commenced on March 31, following the completion of emergency rules put in place during the COVID-19 pandemic, the Center Square reported.

According to the  Kaiser Family Foundation, this reinstatement of rules has resulted in nearly 1.3 million individuals across 22 states losing their Medicaid eligibility.

These figures represent a substantial decrease from the peak of 100 million Medicaid enrollees nationwide, as reported by the  Foundation for Government Accountability.

The Medicaid redetermination process involves the state conducting an annual check of eligibility, which had been temporarily halted during the COVID-19 emergency. This pause in the Medicaid redetermination process lasted from March 2020 until March 31 of this year.

Of the individuals who experienced a loss of coverage in West Virginia, approximately 13% submitted new applications but were ultimately found ineligible to regain their coverage.

The remaining 87% had their coverage terminated as a result of procedural disenrollment. This disenrollment occurred because the state was unable to verify the ongoing eligibility of these individuals, as stated by the Kaiser Family Foundation.

In West Virginia, there are currently 472,000 individuals who have enrolled in managed care plans. Out of these, 26,000 individuals are enrolled in the Mountain Health Promise program, while 121,000 individuals are utilizing the fee-for-service program.

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Actions to Address Medicaid Redetermination Process

Expressing concern over the loss of coverage for eligible individuals, Chiquita Brooks-LaSure, Administrator of the U.S. Centers for Medicare and Medicaid Services, urged states and partners to adopt the strategies outlined to assist individuals in renewing their Medicaid and Children’s Health Insurance Plan coverage or to help them access alternative health coverage options.

She emphasized the need for collaborative efforts between states, advocates, the healthcare industry, and other stakeholders to ensure continued coverage for people.

To address this issue, the U.S. Department of Health and Human Services recently introduced new rules designed to prevent those who still qualify for Medicaid from losing their services due to the Medicaid redetermination process.

These rules include allowing managed care plans to assist with completing portions of renewal forms and permitting pharmacies and community organizations to aid in reinstating individuals who have recently been disenrolled.

HHS Secretary Xavier Becerra stressed that no individual should lose Medicaid or Children’s Health Insurance Program coverage simply because they changed addresses, did not receive a form, or lacked sufficient information about the renewal process.

He encouraged states to leverage all available flexibilities to ensure that children and families do not lose their coverage. Additionally, he urged states to collaborate with local governments, community organizations, and schools to reach eligible individuals and inform them about Medicaid and CHIP.

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