State officials are reporting around 120,000 Iowans have been disenrolled from Medicaid since April.
The Iowa Department of Health and Human Services is four months into Medicaid unwinding, the process of redetermining thousands of Iowans’ eligibility for Medicaid following the end of the national public health emergency this spring.
State Medicaid Director Elizabeth Matney told IPR that the state has sent Medicaid redetermination forms to around 257,000 Iowans so far, and has disenrolled about 25,000 people who no longer meet Medicaid eligibility requirements and another approximately 96,000 people for "procedural reasons," such as not returning their redetermination paperwork by the 60-day deadline or failing to respond to requests for follow up information.
The figure is much higher than state numbers from recent reports to the federal Centers for Medicare and Medicaid Services, which placed that number around 28,000.
State officials estimated in March that around 17.6% — or around 150,000 — Medicaid recipients would be disenrolled in the 12 months following the end of the federal government's COVID-19 pandemic-era requirement that kept most people enrolled on Medicaid, even if they no longer qualified.
Matney said just four months in, Iowa is nearing that initial disenrollment projection because the state has been sending out redetermination forms first to those who were flagged as most likely to no longer qualify for coverage.
She said she expects those numbers to drop sharply in upcoming months.
"We do believe that after these first four or five months that it's going to taper off pretty steeply, because...we front loaded the eligibility determinations in those first months with individuals who are likely ineligible," Matney said.
The state's new figures come the same month as federal CMS officials expressed concern about states that have a high number of disenrollments for "procedural reasons."
"That could be due to lack of awareness, wrong addresses, people not getting a Medicaid renewal form in the mail," Dan Tsai, the deputy director of the Center for Medicaid and CHIP Services at CMS, said at a press briefing earlier this month.
Child and family advocates have previously expressed similar concerns about the Medicaid unwinding process.
CMS officials said since April, they have worked with 12 states to pause Medicaid terminations due to issues related to compliance with requirements, but they have not named which states they have been working with.
According to state data provided to IPR around three-fourths of Iowans have lost their Medicaid coverage since April for "procedural reasons."
More than half of Medicaid renewal forms sent out in June and July have not been returned, according to data on DHHS's website.
Matney pushed back on CMS's recent concerns, saying due to the state's approach to initially prioritizing those flagged as most likely to be ineligible, it's "premature" to be concerned about these figures.
"When we look at the individuals who are going through these procedural disenrollments, about 80% have other health insurance," she said. "So losing Medicaid under this circumstance does not equal losing health coverage."
DHHS has a 90-day grace period for Iowans who have been disenrolled but still qualify to be reinstated with no gaps in their Medicaid coverage.
The state has also launched a texting campaign with the state's managed care organizations to alert Medicaid members that their eligibility forms are coming and is following up with calls and emails, Matney said.
"If we still don't get it, particularly for our individuals who are our most vulnerable so individuals with chronic health conditions or disabilities, we're actually doing door knocking to go face to face looking for these folks and trying to get them to return their paperwork," she said.
