Maryland is engaged in an unprecedented effort to redetermine eligibility for Medicaid — the public health insurance program for low-income people — for the first time in three years.

Roughly 1.8 million Marylanders will have to complete paperwork to reenroll in Medicaid, a process that was paused during the pandemic to ensure access to health care. Over 100,000 people are receiving renewal notices each month over the course of a year.

Though some people are losing their coverage because they’re no longer eligible — likely because they now earn too much to qualify — many others get dropped from Medicaid for “procedural” reasons. That might mean they did not receive or understand renewal notices or did not provide requested documents in time. The Baltimore Banner is tracking how often this happens.

So far, sixty-six thousand people have lost their health insurance for potentially avoidable reasons.

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The exact rate of coverage losses is unclear, however, because renewal data released on the Maryland Department of Health website does not add up. In June, state data lists fewer outcomes than it should. In July and August, it lists more. Numbers vary between documents. The Banner is seeking clarification on these discrepancies.

In August, the state paused procedural coverage losses as it investigates the potentially erroneous coverage losses of 3,153 children over the preceding three months.

Last month, the Centers for Medicare and Medicaid Services informed all states that wholesale disenrollments of all household members under certain circumstances violate federal regulations, since income thresholds are higher for children than adults, so adults in the household may no longer qualify while children still do. CMS ordered states to pause procedural coverage losses and review their renewal processes, while reinstating benefits for those who may have lost them in error.

Maryland has reactivated coverage for the 3,153 children affected while it reviews whether they still qualify, said Chase Cook, acting communications director of the Maryland Department of Health.

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About half of all Medicaid beneficiaries in Maryland are children, and the program covers about 40% of children who reside in the state. In the 15 states reporting renewal data by age, 42% of disenrollments overall were kids. Maryland does not report its data by age, so the percentage of coverage losses affecting children is unknown.

Since people may have moved in the three years since they’ve had to renew their coverage, the state launched a website where they can update contact information online.

Maryland renews coverage for people with SNAP benefits (also known as food stamps) who have not responded to redetermination requests. This has so far allowed 35,000 people to maintain their coverage who would have otherwise lost it.

The state has 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.

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About two-thirds of people nationally were uninsured for a period of time after losing their Medicaid benefits, according to a study using pre-pandemic data, and 40% reenrolled within a year.

These gaps in coverage result in higher administrative costs for the state and sometimes large medical bills for people who by definition lack money to pay them.

People who are uninsured or underinsured tend to avoid nonemergency care due to cost, especially when they are low-income. This can lead to worsening of new or chronic health conditions when they don’t visit a doctor or fill prescriptions, which can cause their health and quality of life to deteriorate and can result in premature death. When patients are uninsured, health care costs go up, as hospitals must provide more advanced care to sicker patients, which then goes uncompensated.

Sarah True was a public health reporter for the Baltimore Banner. She previously worked as a freelance journalist covering healthcare and health policy, and has been both a medical social worker and a health policy analyst in a past life. She holds dual Master’s degrees in public health and social work.

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