A few weeks ago, we talked about the wildly varying and conflicting eligibility limits that a single family or household could have for Medicaid eligibility. We worked through an example for a family of 4 in North Carolina.
Mom and Dad are both 40. Kid 1 just turned 6 and Kid 2 is 11 months old.
Dad loses coverage if family income goes over 41% Federal Poverty Level (FPL) and/or assets are over $3000.
Mom loses full coverage if family income goes over 41% FPL and/or assets are over $3000 AND she loses limited post-partum coverage if family income goes over 196% FPL.
Kid 1 loses full coverage if family income goes over 133% FPL.
Kid 2 loses full coverage if family income goes over 210% FPL.
This matters. Right now, the nation is currently redetermining eligibility for Medicaid for tens of millions of people who gained coverage during the public health emergency. Millions are losing coverage, and millions more are expected to lose coverage.
States SHOULD be redetermining each individual’s eligibility. In North Carolina, if the above household’s income goes to 42%, Dad loses coverage, Mom bumps to post-partum coverage with limited benefits and the kids keep what they have. That is how it should work. That is how it is working in North Carolina, at least until the state legislature passes a budget that expands Medicaid to 138% FPL for adults. North Carolina is doing the re-determination process right.
Yesterday afternoon, the Department of Health and Human Services released a report stating that states are consistently not running their redeterminations correctly:
Thirty states and territories (including the District of Columbia) indicated they are not conducting automatic renewals at the individual level or are still
working to reinstate affected individuals. Impact of this issue varies widely from state to state, and many states are continuing to assess their programs and the impact of the
issue. States that provided estimates reported a wide range in the numbers of individuals impacted or potentially impacted.
Those thirty states are big states, and small states. Those thirty states are red states and blue states and purple states. Those thirty states have generous Medicaid programs and skimpy Medicaid programs. There is no obvious order as to why some states are doing redetermination correctly and others are not.
The states that are screwing things up need to re-redetermine disenrolled individuals at the individual level and hopefully play catch-up to get the likely to be eligible folks back into coverage.
Antonius
I’m finding this whole thing absurdly overcomplicated. How about if the family is at or below the FPL, they all get Medicaid coverage? The cost savings in managing these thresholds would probably go a long way to covering the change.
Kosh III
Yet another reason why Medicare for All should be done.
David Anderson
@Antonius: In states that have expanded Medicaid, that is effectively the case for <138% FPL
David Anderson
@Kosh III: figure out a way to get 218-60-1-5
Antonius
@David Anderson: A start, certainly, thanks!