Colorado purges 800,000 from Medicaid rolls | Health | denvergazette.com

Oct 22, 2024

A year into the COVID-19 pandemic — with the Medicaid rolls swollen with out-of-work and uninsured Coloradans — state decided to keep tabs on enrollees.

It ended up being a fortuitous decision.

As Medicaid is the nation’s health care safety net for the low income and the disabled, this cohort often share similar hurdles: frequent address changes, lack of internet, and cognitive and language barriers, among others.

“A year in, we knew it would end sometime,” said Kim Bimestefer, executive director for the Colorado Department of Health Care Policy and Financing (CDHCPF).

The agency oversees Health First Colorado, the state’s Medicaid program.

Staying in touch with Medicaid recipients throughout the pandemic, she said, was key to not overwhelming the system when the public health emergency designation ended. That task amounted to state officials making more than two million outreaches to 630,000 Colorado households.

Nationally, about 70% of the Medicaid dis-enrollments were procedural, meaning for reasons other than ineligibility, such as state officials being unable to contact recipients.

In Colorado, about 12% of recipients were no longer eligible for procedural reasons, according to a state report.

Medicaid enrollment is renewed annually.

But this was suspended during the COVID-19 public health emergency. That ended on May 11, 2023, triggering what has been called the “Medicaid Unwind,” in which officials began verifying eligibility.

Most who became ineligible did because their income exceeded Medicaid’s limit.

To be eligible for Medicaid, the annual household income, before taxes, for a single person in Colorado must be below $20,030 and $41,496 for a family of four.

Initially, state officials had estimated about 325,000 Coloradans would lose their Medicaid coverage in this process.

The actual number of ineligible Medicaid enrollees in March, the latest data by county available, was nearly 500,000.

“It’s not uncommon to have changes to your forecast,” Bimestefer said.

An untold number of those were likely disabled Coloradans, the primary focus for the state, officials said.

Earlier this year, the Colorado Center on Law and Policy (CCLP) filed a civil rights complaint that asserted the "unwind" discriminated against Medicaid users on disability.

“People were getting terminated from Medicaid and they were the people who needed Medicaid the most,” said Katie Wallat, legal director for CCLP — a statewide advocacy organization that says it works to improve the health, housing and financial security of Coloradans.

Wallat partially blamed case management back logs.

“Once they’re on Medicaid, they tend to stay on Medicaid,” Wallat said. “They’re not going to improve.”

CDHCPF spokesman Marc Williams downplayed these concerns, saying in an email to The Denver Gazette that the state has “extra supports in place to keep individuals needing long-term services and supports connected to coverage at least through the end of the year.”

A 90-day extension that the Centers for Medicaid & Medicaid Services (CMS) provided states to review enrollee eligibility ended in July, Williams said.

State officials are expected to provide a status update on the "unwind" at the end of the month.

Compared to other states, Colorado substantially grew its Medicaid rolls during the pandemic, and officials have pointed to that dramatic spike as a reason for the steep dis-enrollments. That is, because the enrollment rolls grew so big, more people would lose their eligibility once things return to "normal."

“I think we may have been the eighth highest in the country in the terms of new enrollments,” Williams said.

Medicaid is a joint federal and state program that, including the Children’s Health Insurance Program (CHIP), provides health coverage to nearly 80 million children, pregnant people, seniors and individuals with disabilities.

Typically, Medicaid provides health care for roughly one in four Colorado residents. During the height of the public, though, roughly one in three Coloradans were enrolled on Medicaid, Bimestefer said.

She estimated about 10% of enrollees during the pandemic had become eligible for Medicaid for the first time.

More 24 million Americans have been dis-enrolled during the unwinding process, according to federal data compiled by KFF, formerly known as The Kaiser Family Foundation.

In May last year, Colorado had 1.8 million Medicaid and CHIP enrollees, state data shows. That represents a 41% increase since January 2020, when the state had 1.2 million enrolled in Medicaid.

The working assumption was that the Medicaid and CHIP rolls would return to pre-pandemic enrollment levels, once the dust settled.

In March, 1.3 million Coloradans were enrolled. That’s less than 4% of pre-pandemic levels.

But when examining the number of enrollees at the height of the pandemic, the enrollment drop is fairly stark. The average decline in enrollment by county was 27%.

Routt County was among the hardest hit, losing 42% of its Medicaid enrollees, while Cheyenne County saw a 17% drop.

Denver County saw a 24% enrollment decline.

State officials do not know whether the Coloradans booted from the program have obtained health care coverage elsewhere.

This will not likely be known for several months, Williams said.

More than 200,000 Colorado children are expected to lose their health insurance once the federal government’s COVID-19 public health emergency ends.