In the second month of the yearlong effort to renew Medicaid coverage for 1.8 million Marylanders, 17,000 more people have lost their health insurance for “procedural” reasons. This brings the total of avoidable coverage losses to 42,000 over two months.

Of the 139,000 people up for renewal in June, 12% lost insurance for preventable reasons, meaning they either did not receive or understand renewal notices or did not provide requested documents in time. That’s down from 25% in May, the first month of coverage losses for people with Medicaid — the state-administered public health insurance program for low-income people — as the state undertakes an unprecedented effort to renew benefits that were frozen for three years during the pandemic. States began the mass renewal process around the end of the federal public health emergency on May 11.

The Maryland Health Benefits Exchange had previously estimated that 80,000 Marylanders could lose Medicaid benefits over the course of the redetermination period, and have now reached over half that number in the first two months of coverage losses.

An additional 11,000 Marylanders lost Medicaid coverage in June because they were no longer eligible — likely because they now earn too much to qualify. Household income must not exceed 138% of the federal poverty level, or $41,400 for a family of four. The state refers people who are over the income limit to apply for health insurance on the state exchange, where they may still receive subsidies to help with costs.

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June’s coverage losses coincide with a warning issued to states from the Biden administration to slow down on coverage terminations. Seventy percent of disenrollments nationwide have occurred for procedural reasons, or red tape. Some states have disenrolled a massive number of people from Medicaid as a result of a renewal effort still in its early stages. In Arkansas, a state with about half the population of Maryland, 141,000 people lost coverage over the first two months — over 80% for procedural reasons.

“Nobody who is eligible for Medicaid or the Children’s Health Insurance Program should lose coverage simply because they changed addresses, didn’t receive a form, or didn’t have enough information about the renewal process,” said Department of Health and Human Services Secretary Xavier Becerra in a letter to all governors. “We encourage states to utilize all available flexibilities to ensure children and families don’t lose coverage.”

Many Medicaid enrollees may have moved in the three years since they’ve had to renew their coverage — especially since low-income people are more likely to be unstably housed. In an effort to ensure the state has correct contact information, Maryland launched a “Medicaid check-in” outreach campaign and a website where people can update their information online.

Maryland was among a minority of states that declined to allow the managed care organizations administering Medicaid benefits to update beneficiaries’ contact information, despite electing to include them in outreach efforts. That means people with Medicaid might receive a call from a managed care organization telling them to update their contact information, but they’d have to hang up and call a different agency to do so — an extra and sometimes time-consuming step.

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Maryland has recently been granted federal approval to allow managed care organizations to update enrollees’ contact information when assisting them in completing renewal forms, said Ryan Moran, deputy secretary of health care financing and Medicaid director at Maryland Department of Health. But the managed care organizations still can’t update contact information when they’re simply reaching out.

Maryland has also elected not to obtain beneficiaries’ contact information from the United States Postal Service change of address database, as most other states have done.

“Maryland is confident with its current strategies to allow the MCOs to update contact information during their assistance with applications while also leveraging the Maryland Health Exchange’s contact information and outreach efforts,” Chase Cook, acting director of communications for the health department, said in an email.

Cook noted that Maryland has taken advantage of 13 of the “flexibilities” — ways that the federal government has loosened its rules to help people maintain their coverage — with two more awaiting approval.

One federal rule change which has had a substantial impact, said Moran, is the state’s ability to renew coverage for people with SNAP benefits (also known as food stamps) who have not responded to renewal requests. This flexibility resulted in 5,500 people maintaining coverage in May who would have otherwise lost it, and an additional 9,000 people in June.

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Maryland has also instituted a 120-day reconsideration period in which people who lose benefits for procedural reasons can submit or add to their applications and, if eligible, coverage will be reinstated retroactively starting on the day they lost it.

“Our goal at the end of the day is to ensure that everybody who is eligible for Medicaid receives coverage,” Moran said.