South Carolina will soon begin reviewing hundreds of thousands of people who got health coverage through Medicaid during the pandemic to see if they can keep it, which could affect the families of more than 90,000 children.
The S.C. Department of Health and Human Services, however, is taking a deliberate approach that means some reviews will not happen for a year as it goes through about 1.3 million people.
Under the federal Families First Act passed in March 2020, states like South Carolina got a 6.2 percent boost in Medicaid funding to help them deal with the pandemic, including potential increases in enrollment caused by those losing their jobs and children becoming newly eligible.
In return, the states agreed not to kick anyone off while the federal Public Health Emergency was in effect. The emergency declaration was renewed every 90 days over three years but will now expire on May 11.
However, recent federal legislation dictated that the continuing coverage of Medicaid recipients could end before that on March 31, which means states are free to begin the reevaluation and disenrollment of those deemed no longer eligible beginning April 1.
South Carolina will begin that process then but will take the full 12 months recommended by federal health authorities to conduct the review. That has been the department's plan all along, spokesman Jeff Leieritz said.
"We’ve not wavered from that plan to take the 12 months to make sure that we’re doing our due diligence and carrying out this process effectively," he said.
But those redeterminations have led to great concerns that millions across the country will lose their health insurance, some because they no longer qualify but others because they do not receive renewal notices or other important paperwork they need to stay enrolled. Advocates have dubbed it "the unwinding" of Medicaid recipients.
The federal Centers for Medicare and Medicaid Services estimates that Medicaid enrollment grew 32.2 percent from February 2020 to October, or 20.5 million. In South Carolina, those on Medicaid grew from 1.05 million to approximately 1.3 million at the end of December, Leieritz said, or by about 250,000.
Many of those recipients will likely lose coverage, however. According to an estimate from the U.S. Department of Health and Human Services Office of Health Policy, 17.4 percent of adults and children on the program, or 15 million people, will be booted off during the process.
A little more than half, 9.5 percent or 8.2 million, will lose coverage because they no longer qualify, HHS reported. But 7.9 percent or 6.8 million will likely lose coverage despite still being eligible, whether through miscommunication, lack of a current address or other bureaucratic barriers or mistakes, the federal agency estimated.
That includes 3.9 million children nationwide. Children on Medicaid in South Carolina on the program grew from 654,000 to 744,000, or by 90,000.
But that includes many of those who would likely have aged out of the program when they turned 19 were it not for the prohibition against ending coverage, Leieritz said. Those kinds of reviews, looking at people who are not likely to still be eligible for Medicaid, will be an early part of the process, he said. Others would be people who typically are only on Medicaid for a set period of time.
Refugees, for instance, are eligible for eight months before they are reviewed to see if they qualify for coverage in other ways, said Lori Risk, chief of the Bureau of Eligibility Policy for South Carolina Medicaid.
The state will use electronic data sources, such as the S.C. Department of Employment and Workforce, to check income eligibility, and if verified, may be sending members a "continuation of benefits" notice instead of a renewal form.
At least seven states already began that "ex parte" renewal process Feb. 1, including Arkansas, Ohio, New Hampshire and Idaho, said Joan Alker, executive director of the Georgetown University Center for Children and Families. Reviews take at least 60 days, she said.
"If states want to start terminating people April 1, which is the first date they can terminate people, then they are starting now," Alker said. That South Carolina is taking the 12 months for its review "is good," she said. "The quicker the state goes, the more chance there is for error."
South Carolina Medicaid has set up a website for members to update their information if they have moved in the past three years or are unsure if the state has the correct address at apply.scdhhs.gov. The state will use text and emails to follow up with members who have a phone or address on file. The department will also call members when possible if there is returned mail with no forwarding address or other way to ascertain an address, Risk said.
The Georgetown center will be releasing data later this week on how the continuous coverage on Medicaid has broadened health insurance in the U.S., particularly for children. More than half of them are now covered by Medicaid.
Those enrollment gains led to big drops in the uninsured rate for children, such as in South Carolina, where the rate dropped from 5.8 percent to 5.3 percent.
Children are the most likely to remain eligible for Medicaid but are at risk for being dropped if their family doesn't get the renewal notice or hits another bureaucratic wall, Alker said.
"This is of huge consequence for children," she said.