The Maryland Department of Health said nearly 25,000 Marylanders — or 21% of the 120,000 up for renewal in April — lost their Medicaid coverage as of June 1 as part of the massive redetermination process the state is undertaking due to the end of the COVID-19 public health emergency. These are the first enrollees to lose benefits as part of this effort.

Beneficiaries lost coverage for “procedural” reasons; either they did not submit their applications on time or did not provide requested documents. Another 10,000 lost coverage because they were no longer eligible, most likely because their incomes are now too high.

“We know that our work moving forward must continue from an all-hands-on-deck approach,” to minimize preventable coverage losses, said Ryan Moran, deputy secretary of health care financing and Medicaid director at the Department of Health.

The state is in the midst of an unprecedented effort to renew Medicaid coverage for nearly 1.8 million adults and children for the first time since the start of the pandemic. States were required to provide uninterrupted coverage for those enrolled in Medicaid, the public health insurance program for low-income people, throughout the pandemic in exchange for increased federal funding.

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The procedural losses in coverage that have now impacted 25,000 in Maryland over just one month’s worth of renewals are the type that the Centers for Medicare and Medicaid Services wants states to avoid, and required them to submit plans detailing how they would do so.

Maryland is doing Medicaid renewals on a rolling basis with notices mailed to beneficiaries in the same month that their coverage began, regardless of its duration. The first notices were sent out in April and will continue to be mailed each month over the course of the following year.

Moran said 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 and back-dated to the day they lost it.

State officials have focused on grassroots outreach efforts in partnership with community organizations, local health departments, health care providers and others, Moran said, to get the word out that Medicaid renewal is no longer automatic and people must update their contact information to ensure notices will reach them.

Maryland has set up a website where people can update their contact information online. People who lack access to the internet — roughly 20% of those living near the poverty line — or who have a question about their enrollment, must call the Maryland Health Connection.

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While more than 30 other states have elected to obtain beneficiaries’ contact information from the United States Postal Service change of address database or the Medicaid-managed care organizations tasked with administering benefits, Maryland has not done so. That means managed care organizations, while they are among the groups doing outreach on behalf of the state, are limited to a messenger role.

Although June marks the first month of coverage losses in Maryland since the Medicaid renewal process began, the percentage of people who’ve lost coverage for procedural reasons is so far the lowest of seven other states publicly reporting data. Pennsylvania is second lowest at 43% and West Virginia is highest at 89%. Some states started the renewal process one to two months earlier and have more data to report.

Overall rates of coverage losses — both procedural and those that occur because beneficiaries are no longer eligible — average 34% nationwide so far, and 29% in Maryland.

Still, officials at the Maryland Health Benefits Exchange had previously estimated that 80,000 Marylanders could potentially lose Medicaid benefits over the course of the redetermination period, and have now reached over 40% of that number in the first month of coverage losses.

Moran said drawing any conclusions from the data is premature at this point, given that the state is still so early in the renewal process. Regardless, the Health Department will keep a close eye on the monthly numbers as they’re released, he said, and will be “calibrating our approach as necessary.”

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Even under ordinary circumstances, though, procedural losses in coverage are common among Medicaid beneficiaries when submitting their annual renewals — they may not receive or understand notices, may not provide requested documents in time, or might experience a short-term fluctuation in income that renders them temporarily ineligible.

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% re-enrolled within a year.

These gaps in coverage often experienced by Medicaid beneficiaries are known as “churn,” and can result in large bills for people who by definition lack money to pay them. Some may have a chronic condition that must be managed, and some wind up at the emergency room or in the hospital — which may be the point when they realize they no longer have health insurance.

This story has been updated.

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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