April 1 marks the first day the Iowa Department of Health and Human Services can begin dis-enrolling Iowans from Medicaid since the start of the national public health emergency three years ago.
The process is called Medicaid unwinding, and state officials said they anticipate it will take a year to get through.
What is Medicaid unwinding?
At the start of the national public health emergency in March 2020, one of the federal government’s requirements for giving states some fiscal relief from COVID under the Families First Coronavirus Response Act was that they were not allowed to disenroll anyone from Medicaid from March 18, 2020, onwards.
In December 2022, President Biden signed the Consolidated Appropriations Act that ends that requirement as of April 1, which means the state can now start disenrolling people who it determines no longer qualify for Medicaid.
How many Iowans will this affect?
State officials estimate around 17.6% of current Medicaid members – that’s somewhere around 150,000 Iowans – will be disenrolled during the unwinding period.
The Iowa Department of Health and Human Services said more than 860,000 Iowans are enrolled in Medicaid as of March, which is up around 200,000 enrollees from early 2020.
More than one in four Iowans are now on Medicaid.
How will this unwinding process work?
Iowa officials said they’re planning to stagger this process over the course of 12 months.
The state is mailing out eligibility redetermination forms to all Medicaid members, but they’re focusing on about 50,000 redeterminations a month.
This means not all Medicaid members will get these forms right away. It could take a few months.
Elizabeth Matney, the state Medicaid director with the Department of Health and Human Services, said the state is doing it this way so its staff isn’t overwhelmed.
“When you think about how to space that out in a way that the workforce can absorb it, as well as our IT systems, our mailings, making sure that we're doing all of those extra steps to get in touch with members if the addresses aren't correct, we had to space it out over some time,” she said.
The state will first focus on contacting members it has flagged as potentially having incomes too high to qualify, and those who have not had any kind of eligibility redetermination with the agency in the past 12 months.
Matney said the state’s already been working for months to get word out to members about the upcoming unwinding process.
“We're posting regularly on social media. We're sending out postcards and other mailings, just reminding folks to make sure to check their mail for their redetermination paperwork,” she said. “Our managed care partners are doing those text campaigns to get in touch with folks directly.”
She said the most important thing for Medicaid members to do now is to make sure that DHHS has their correct address on file to get eligibility re-determination forms some time in the next 12 months.
What are the concerns about this unwinding process?
One of the biggest concerns family and child advocates have about unwinding is that people who still qualify for Medicaid will end up getting dis-enrolled due for “procedural reasons,” or when they don’t turn in their re-determination paperwork or turn in incomplete paperwork.
Allie Gardner, a senior research associate with the Georgetown University Center for Children and Families, said there’s a lot that could go wrong for Medicaid members in this process.
“When someone doesn't respond to their renewal form, it's not because they don't care about their Medicaid coverage,” she said. “We're talking about a lot of bureaucratic hurdles and red tape that people are having to navigate through, possibly for the first time,” she said.
Some of those bureaucratic hurdles include things like DHHS not having the correct address on file because someone has moved, a member sitting on hold for hours when trying to update that address, or members not understanding the forms because they don’t speak English very well.
Anne Discher, the executive director of Common Good Iowa, which advocates for children, said making sure there’s clear communication from the state is key.
“What you don't want to have happen is a family shows up to get a prescription filled, and suddenly, they realize only when they can't get the medication that they don't have coverage,” she said.
However, state officials have acknowledged that Medicaid eligibility forms can be really confusing in general.
“We have historically had notices that are very hard to understand,” Matney said. “They're not in really common language, right? Sometimes I read the notices, and it's hard for me to understand. So we have taken some efforts related to providing additional clarification.That said, we still have room to go.”
But Matney said if Medicaid members have questions about your Medicaid forms they should contact DHHS – or their managed care organization for help.
If Iowans do lose their Medicaid coverage, what options do they have?
The state said those who are losing coverage will be directed towards the ACA marketplace to find a plan – as well as any subsidies that could make that plan more affordable.
If Medicaid members lose coverage, and think they still qualify for it, there is a 90-day grace period where DHHS can re-enroll them.
Matney said she encourages anyone who is in this position to contact DHHS right away.
“If you happen to lose coverage, because you didn't return paperwork, despite all of our efforts to reach out, please do get back in touch because there is a grace period where we can reinstate your coverage back to the date that it was lost,” she said.
Iowa Medicaid Contact Information
Medicaid Member Services
Phone 1-800-338–8366
Email IMEmemberservices@dhs.state.ia.us
Hawki Member Services
Phone 1-800-257-8563
Email hawki@dhs.state.ia.us
Information on Iowa's Medicaid unwinding plan
Upcoming monthly DHHS virtual town halls for Medicaid members
