With the publication of data from September, Indiana is now halfway through the Medicaid "unwinding" process, where do we stand? (Getty Images)
As Indiana hits the halfway point for the Medicaid unwinding process, the rate of Hoosiers losing benefits seems to have slowed as the state reassesses the coverage of millions of beneficiaries following the expiration of pandemic protections.
However, with a total of 231,403 Hoosiers kicked off of the rolls, Indiana could potentially exceed an earlier estimate that predicted only 300,000-400,000 Hoosiers would lose coverage.
During COVID-19, the federal government barred states from purging their Medicaid rolls during the economic tumult and enhanced their match, paying for nearly three quarters of the cost of coverage rather than the traditional two-thirds.
Indiana’s rolls grew from just over 1.5 million enrollees in February of 2020 to over 2.3 million in March of 2023, the last month of protections.
Now halfway through the process of “determining” the eligibility of each enrollee, 231,403 Hoosiers no longer have Medicaid coverage, as reported by the Family and Social Services Administration for the months of April through September, the latest month available.
Cora Steinmetz, the state’s Medicaid director, shared her perspective on a panel with the Medicaid and CHIP Payment and Access Commission (MACPAC) on Thursday, a body of experts who report regularly to Congress about the status of government insurance programs.
Steinmetz called the process “extremely challenging” to implement as the expiration of the public health emergency kept getting delayed month after month, impacting how the agency could shore up call centers and ready their staff.
“… it was challenging to be in sort of an ongoing standby situation, quarter after quarter,” Steinmetz said. “Every quarter we would do the preparation and I think after so long you become numb to the same message of, ‘It might be coming. It might be coming.’”
Despite the difficulties, Steinmetz said she felt the agency had “navigated it well and are pleased with the sort of outreach we ended up with.”
What does outreach mean?
A few months into the unwinding period, Steinmetz said FSSA launched a data dashboard on the behest of stakeholders like the Indiana Hospital Association and Minority Health Coalition, many of whom can help current beneficiaries keep their coverage if they’re still eligible.
“Those partners really are the boots on the ground, assisting with outreach efforts, and they were very clear with us that if we could make as much data public as possible that would really inform their ability to get out and reach as many Medicaid members as possible,” Steinmetz said.
Though initially just a rehash of the monthly reports to the Centers for Medicare and Medicaid Services (CMS), the data now includes demographic information and county-level details.
In particular, Steinmetz said the availability of county-specific data helped those entities target vulnerable populations to distribute information on redetermination. This also helps the agency better tailor its communications with members.
“One example of this is that our dashboard data … (showed) the largest procedural disenrollment was our Healthy Indiana Plan (HIP),” Steinmetz said. “We’ve now pivoted our messaging to really target family advocates to encourage family advocates to reach out … we also have our messaging now really reiterating (that) parents should take action even if they no longer qualify because their children may remain eligible.”
The number of Hoosiers dropped from the rolls has decreased most months and averages 38,567 Hoosiers at the halfway point — a significant drop from the 53,000 lost in both April and May.
Steinmetz credited the work of partner organizations for continuing to spread the word about the redetermination process.
“We really embrace sort of a ‘whole government’ response to getting the word out because we know that our Medicaid members are served by many other state agency programs and they really have great connection points,” Steinmetz said.
Steinmetz noted the distribution of renewal information materials through the Department of Workforce Development WorkOne Centers, the Department of Health’s WIC clinics and the Department of Child Services. Outside of individual agencies, FSSA has tried to leverage first responders, food banks, pharmacists and schools to keep materials on hand for enrollees.
“We collaborated with the Indiana Bureau of Motor Vehicles and located 80,000 addresses that were different for Medicaid members than what was registered with the (BMV) and provided direct outreach via postcard to those mismatched addresses to try to address that,” Steinmetz said. “We’ve really tried to make sure that we have a consistent message across all of the various entities so that Medicaid members are hearing this drumbeat from the ground level about what action is needed.”
Flexibilities from the pandemic
In addition to enhanced funding, CMS permitted many experimental waivers for services, such as submitted information via text or email — which Steinmetz called “incredibly useful” when it came to contacting younger beneficiaries.
Steinmetz said Indiana had adopted many such flexibilities under temporary waivers — such as leveraging eligibility in other government programs like supplemental food benefits or social security — and many could be incorporated permanently, if given the nod from the CMS.
But, for now, Steinmetz said there wasn’t yet a way to track which specific waiver had helped an enrollee.
“That’s just not how we are necessarily tracking from our renewal outcome standpoint but I think we will have the ability … especially as we move into the second half of our unwind period,” Steinmetz said.
For now, those flexibilities are slated to expire at the end of the redetermination process.
Moving forward from the halfway point, Steinmetz said the agency wanted to make sure it kept communications in “plain language” so enrollees up for redetermination could understand what was needed.
“This is very technical information and so I think we do continue to think about what we need to do to make sure that the information is as understandable as possible for members and beneficiaries. That they have the resources they need to understand what is being asked of them from a redetermination standpoint,” Steinmetz said. “That’s an area even beyond the unwind period we’ll continue to pay close attention to.”
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