Medicaid disenrollment could affect 650,000 in Arizona. Here's how to keep your coverage
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In March 2020, Congress passed the Families First Coronavirus Response Act to lessen the economic burden placed on states by the health emergency.
The act funded state COVID testing, paid leave and food stamps; and barred states from kicking people off Medicaid, a U.S. government program that provides health-care coverage to eligible low-income individuals and families.
Consequently, Medicaid rolls expanded.
“As of the end of March [2023], over 93 million people were enrolled in the program — an increase of over 30% since the start of the pandemic,” said Jennifer Tolbert, associate director of the Program on Medicaid and the Uninsured at KFF, formerly known as the Kaiser Family Foundation.
Those are national numbers. In Arizona, the Arizona Health Care Cost Containment System — the state’s Medicaid agency — saw its rolls swell to 2.5 million, 650,000 of whom likely no longer qualify for the program.
“They either did not complete their renewal that's due every six or 12 months, or they were over income, but AHCCCS could not drop them,” said Matt Jewett, director of health policy at Children's Action Alliance, an Arizona-based non-profit that promotes child and family well-being.
The 'Great Unwinding'
That bar lifted last December, when the Consolidated Appropriations Act ended continuous enrollment, dialed back federal funding and set the stage for millions to lose coverage.
Although states knew the act was coming, many had not kept their books up-to-date during the pandemic, in part due to layoffs. But AHCCCS had, and wasted little time in reaching out to borderline cases.
“AHCCCS is doing roughly 230,000 each month that are getting a new letter for the first time saying, ‘You are up for renewal; you need to respond,’” said Jennifer Burns, senior director for government and media relations at Arizona Alliance for Community Health Centers (AACHC), the overarching primary care association for Arizona’s community health centers.
In many cases, automated systems gather relevant data such as household income from state files, thereby completing an automatic, ex parte renewal.
“So, in two-thirds of the cases, at renewal time, people get a letter saying, ‘Congratulations, you've been automatically renewed,’” Jewett said.
For everyone else, there’s a roughly yearlong unwinding period that varies by state; Tolbert said some jurisdictions already had a drop list ready to go.
“We expect the disenrollment rates among these flagged individuals to be higher than what we would see among enrollees who are not flagged,” she said.
Arizona began sending renewals in February, warning that disenrollments would start in April.
“Arizona began dropping people who were not completing their renewals or who were over income on April 1,” said Jewett. “We were one of the first, I believe, five states to start doing that.”
But the Centers for Medicare & Medicaid Services also set guardrails that require states to meet new reporting standards and to give 30 days notice on renewals. Most states grant 45 to 90 days.
Arizona can pause or slow renewals for 30 days if needed.
“That's not something that AHCCCS has decided to do or felt the need to do,” said Jewett.
Procedural disenrollments
First to be cut from the rolls were those with incomplete renewals. Nationally, that’s a high percentage.
“Seventy-three percent of the disenrollment so far that we've seen were due to these procedural disenrollments,” said Tolbert.
She said the proportion dropped from Medicaid rolls varies greatly by state.
“So, for example, the disenrollment rate in Texas is 82% and 76% in Idaho, at one end of the spectrum, and 10% in Michigan, at the other end,” she said.
Arizona comes in at 31%.
Jewett said the state’s large rural and tribal populations pose an additional challenge to timely postal exchanges.
“If they have to provide any sort of information to AHCCCS to stay enrolled, they may not have adequate time for people in rural areas or tribal areas, where it takes longer to get the mail,” he said.
But for many, returning such paperwork seems pointless because they no longer qualify — or so they think. Jewett said they might not know what AHCCCS does and doesn’t count as income.
They also might not realize that their children still qualify for KidsCare, an AHCCCS program that offers health insurance for children under age 19 who are not eligible for other AHCCCS health insurance.
“The Arizona Legislature and Governor (Katie) Hobbs raised the eligibility for KidsCare,” he said. “So, sometime this fall, we expect the eligibility will go from 200% of the federal poverty level to 225%.”
Help navigating the system
Claudia Maldonado, AACHC director of outreach and enrollment, said engaging with the process can also put Arizonans in touch with navigators. That can happen through her organization or via the Health-e Arizona Plus system, where a joint application determines eligibility for Medicaid, SNAP nutrition assistance and TANF cash assistance.
“You know, making a health-care decision is a big change, and you want to make sure that you have a plan or a program that best fits your needs,” she said. “And so this huge network of navigators and assisters really solely exists to help the community through this process.”
Free consultations are available by dialing 211 or by visiting coveraz.org and its Get Covered Connector, where Arizonans can sign up for free consultations about AHCCCS applications and renewals.
“Unfortunately, some of our community members still don't realize that these networks exist, that there are folks that are bilingual; we have language lines,” Maldonado said.
Navigators can help those dropped from Medicaid find coverage on the health insurance marketplace.
Jewett said that resource is worth a second look.
“Some people may have looked at it nearly a decade ago, when it debuted, and thought it was way too pricey,” he said. “And now it may be much more affordable due to increased tax credits.”
In short, affected Arizonans should return their paperwork and log onto healthearizonaplus.gov to check their status.
“Of 74,000 people who completed their renewal within 90 days after they were procedurally discontinued, 46% of them got back on,” said Jewett, referring to the fact that those who lost coverage because of a missed renewal deadline have 90 days after their end date to respond.
“You can still apply anytime for Medicaid; you don't have to be within 90 days,” said Burns. “But if you do it within the 90 days, it's much simpler, because the application is already populated for you.”
