As Virginia resumes its annual process of recertifying Medicaid recipients’ eligibility after a three-year break, health care and government officials are urging recipients to update their contact information on file with the state to make sure there’s no disruption in coverage.
The resumption of the annual Medicaid eligibility determination after a COVID-19 pandemic-related hiatus is known as the “return to normal enrollment,” or “unwinding.” It’s a major undertaking that kicked off this month and is scheduled to last into spring 2024.
During this time, officials expect an estimated 300,000 people across the commonwealth to lose their eligibility for Medicaid, the joint federal and state program that provides health care to low-income families, qualifying pregnant women and children, and many people with disabilities, among others.
Many likely will need help reapplying for Medicaid, overcoming hurdles related to paperwork and other administrative processes, or finding other health care options such as private insurance, a government exchange plan, or services provided by Virginia’s network of free clinics and community centers.
“We knew this was coming. It’s hard to tell how this is going to play out,” said Janine Underwood, executive director of the Bradley Free Clinic in Roanoke.
The Bradley Free Clinic serves about 3,500 patients a year in the Roanoke Valley area, of whom Underwood estimated about 60% are uninsured and 40% are on Medicaid. Underwood said she anticipates the unwinding process will result in more patients seeking care from the clinic as some Medicaid recipients lose eligibility.
“Even if it’s until they can re-enroll again, they’re going to need a medical home,” Underwood said. “We’ll be here for the uninsured, and I do expect our numbers to increase for uninsured.”
Restarting the regular recertification process
The federal public health emergency declared in March 2020, at the start of the COVID-19 pandemic, required Virginia and other states to suspend their usual yearly Medicaid renewal processes as one of several conditions for receiving enhanced federal funding.
This came on the heels of Virginia expanding Medicaid in 2019 under the Affordable Care Act by increasing the income threshold for eligibility.
Medicaid enrollment in Virginia then soared by more than 40% during the pandemic, from 1.53 million to approximately 2.2 million, according to figures from the Virginia Department of Medical Assistance Services.
Of that 2.2 million, more than 500,000 are in Southwest, Southside and the Alleghany Highlands, according to figures available from DMAS.
With the public health emergency — and that extra federal money — now coming to an end, Virginia has begun resuming its regular annual recertification process.
During that time, an estimated 14% of Virginia Medicaid recipients, or about 300,000 people, will lose Medicaid eligibility, according to Rebecca Dooley, acting communications director for DMAS.
That 14% is below the national average of 20%, according to DMAS.
Reasons people might lose eligibility vary, Dooley said. Some might have changed jobs and therefore their income changed, or they now have health insurance through an employer. A change in household size could also affect eligibility.
No one will be disenrolled from Medicaid before April 30, Dooley said.
In addition to the 14% who lose eligibility, another 4% of recipients are expected to lose eligibility but will re-enroll within six months, which is known as churn.
To ensure that eligible Medicaid recipients continue to receive coverage, officials are asking them to update their contact information via one of the following:
- online at commonhelp.virginia.gov;
- calling Cover Virginia at 1-833-5CALLVA;
- calling their local Department of Social Services; or
- contacting their health care plan manager.
“We encourage all households to keep their contact information (address, email and phone number) up to date and to keep an eye out for information from us in the mail and respond to anything sent to them as quickly as possible so that we can review and determine their ongoing coverage,” Dooley said in an email.
Maintaining continuity of care
Some Medicaid members will be automatically renewed if the state has all of the information it needs. In those cases, the member doesn’t need to do anything, Dooley said.
But if the state needs more information, it will need to contact the Medicaid recipient.
“If a member fails to submit the necessary information to complete their renewal, then they are at risk of losing their health coverage,” Dooley said.
Some Medicaid recipients likely will be declared ineligible because of paperwork problems or other administrative reasons, said Sara Cariano, senior health policy analyst with the Richmond-based Virginia Poverty Law Center, an advocacy group whose mission is to break down systemic barriers that keep low-income Virginians in poverty.
While Virginia has worked to improve systems to make automatic Medicaid renewals more efficient, Cariano said she has concerns about recipients who can’t be automatically renewed and who might not receive information that is mailed to them.
Besides the task of ensuring that a recipient’s address is up to date, if mail delivery to the recipient’s home is unreliable, the recipient might not receive the materials necessary to reapply for Medicaid.
“Even if you did everything right, there could be something that happens outside of your control and outside of the state’s control where you just don’t get that package, and so you can’t respond,” Cariano said.
Furthermore, much of the renewal processing will be handled by local social services departments, which may be understaffed and are already working on other benefits such as the Supplemental Nutrition Assistance Program, or SNAP, she said.
“This increase in workload is really going to strain these local offices that are just kind of already working at capacity,” Cariano said.
Cariano said that during the unwinding process, her organization will advocate for Medicaid enrollees, including by answering questions about the renewal application or providing translation services for those who speak a language other than English. VPLC can also help those who lose eligibility understand their next options.
At the Bradley Free Clinic, Underwood said her organization is fortunate to have a Project Connect outreach worker, thanks to the Virginia Health Care Foundation, a public-private partnership that helps uninsured and underserved Virginians access health care.
While the Project Connect worker is based at the clinic, she works with anyone in the Roanoke Valley who needs help enrolling in Medicaid for the first time or renewing an application, Underwood said.
The Free Clinic of Central Virginia, in Lynchburg, offers medical care for uninsured patients but not those on Medicaid, although it offers dental care for both uninsured patients and those on Medicaid, said CEO Jen Webb.
As Medicaid enrollment grew during the pandemic, and many uninsured people were added to the Medicaid rolls, patient traffic there decreased, Webb said. She expects to see that trend reverse as people come off Medicaid.
Webb said she thinks people who have had coverage and haven’t had to reapply, or who are unaware about the changes to Medicaid enrollment, could be blindsided when they show up to a hospital or doctor’s office and are told they don’t have insurance anymore.
“That’s kind of what I think is going to be the bigger headache of all of this, personally,” she said.
Webb emphasized it’s important for people who lose their Medicaid eligibility to use available help, such as free clinics, to figure out their next steps.
“It’s complicated, it’s confusing, it’s overwhelming, but at the end of the day, there are a lot of resources that have been created, both on the state and federal level, to help people through this. … Just because you may have lost or will lose your Medicaid coverage does not mean that you have no access to service.”
Meanwhile, health care plan providers — for example, Anthem, Aetna or UnitedHealthcare — and DMAS are sharing information with each other to try to find the best ways to contact Medicaid recipients, said Doug Gray, executive director of the Virginia Association of Health Plans, a member organization that represents health plans in the commonwealth.
In some cases, the health plan might have more up-to-date contact information for a Medicaid recipient than DMAS does, or it can reach a recipient directly through a plan’s care coordinator, Gray said.
If someone who previously had Medicaid is now ineligible, they’ll be referred to the federal health insurance exchange at Healthcare.gov — or, starting this fall, the Virginia Health Benefit Exchange.
“Some of the people that were no longer eligible for Medicaid — let’s say they found a job and their income went up too much, but they still don’t have benefits — will be able to get benefits through the exchange, and those will be subsidized,” Gray said.
A health plan provider that manages a now-ineligible Medicaid recipient’s health plan can also try to enroll that recipient in an exchange plan, if the provider has one, Gray said, thus keeping the recipient covered under the same provider.
“Part of that mission there is to try and make the transition as easy as possible,” Gray said.
Earlier this month, more than 300 health care advocates, Medicaid providers and others attended an “Unwinding Summit” in Richmond to prepare for this large initiative.
Participating partners included the state Department of Medical Assistance Services, the Virginia Poverty Law Center, the Virginia Health Care Foundation, the Virginia Association of Health Plans, the Virginia Health Benefit Exchange and the Virginia Department of Social Services, according to a news release following the summit.
“Reviewing eligibility for all 2.2 million Medicaid members is a tremendous task that requires the collaboration from all of our partners,” Sarah Hatton, DMAS’ deputy for administration, said in the release.
For more information on the Medicaid redetermination process, visit CoverVA’s Return to Normal Enrollment website.