Many CMS waivers that were set to expire in 2024 are being extended.
The Centers for Medicaid and Medicare Services have extended the flexibilities designed to help states keep eligible individuals enrolled in Medicaid through June 2025, revising the initial expiration set for the end of 2024.
The waivers were originally set to expire by the end of 2024, but will be extended for six more months, according to a memo to states written by deputy CMS administrator and director of the Center for Medicaid and CHIP services Daniel Tsai. Other unwinding-related section waivers will be extended through June 30, 2025
According to a memo to states written by deputy CMS administrator and director of the Center for Medicaid and CHIP services Daniel Tsai, many states were expected to finalize the Medicaid unwinding process by June of 2024. However, due to several state extension waivers from CMS, several states will continue renewals past this date.
Loss of Coverage
Originally, HHS estimated that roughly 15 million individuals would lose Medicaid coverage. According to KFF news, over 21 million individuals have been disenrolled from Medicaid since April 2023.
Of that number, around 69% were disenrolled for procedural reasons, for example, not returning mandatory paperwork; not because they were ineligible for the program. The total Medicaid/CHIP Enrollment as of March 2023 was 94 million individuals, almost a third of the national population.
CMS looked at this massive volume of renewals following resumption of normal operations and called for the states' use of the timeliness exception to delay procedural disenrollments. This gave states time to conduct targeted outreach to encourage beneficiaries to return the renewal form.
CMS has approved a total of 398 waivers 52 states and territories, including Puerto Rico and the U.S. Virgin Islands. The waiver uptakes varied greatly by state: South Dakota requested a single waiver, while Indiana and Tennessee requested 15 each.
CMS also noted that this extension of flexibilities to streamline renewals will enable states to shift limited resources to reduce processing time at application when needed.
Payers
Health plans have faced much scrutiny as Medicaid unwinding moved along, and many payers still profited. Initially, payers said they expected the overall risk profile of their members to go up, due the fact that those remaining in the program would be sicker.
During the pandemic Medicaid enrollees’ health costs were lower, and several states made the decision to exclude pandemic-era cost data as they moved to set up payment rates for 2024; which worked in the favor of Medicaid health plans.
According to KFF, there are still 24 million Medicaid beneficiaries awaiting states to determine eligibility.
Marie DeFreitas is the finance editor for HealthLeaders.
KEY TAKEAWAYS
Medicaid unwinding has left many eligibility enrollees without coverage
CMS has extended several state waivers into keep members enrolled until 2025
Health plans have still come out on top during the Medicaid unwinding process