The Mississippi Division of Medicaid removed another 22,000 Mississippians from its rolls in July in the second wave of disenrollments after the end of pandemic-era protections.

That brings the agency up to 51,967 disenrollments total during the unwinding process, with those numbers set to increase.

Beginning in March 2020, federal law prohibited state divisions of Medicaid from removing people from their rolls due to the COVID-19 public health emergency.

The emergency ended in May, and now agencies are reviewing the eligibility of their beneficiaries for the first time in more than three years.

According to one expert, Mississippi’s total number of disenrollments is not the most concerning statistic: It’s the fact that 80% of the people dropped so far have been disenrolled because of issues with their paperwork, which could mean many of them were still eligible.

“It’s very high,” said Joan Alker, executive director of Georgetown University’s Center for Children and Families. “Yeah, that’s very problematic.”

Many of the people who have been procedurally disenrolled could be children. Kids in low-income families make up more than half of Mississippi’s overall Medicaid beneficiaries.

According to Mississippi Medicaid’s enrollment reports, 18,710 children have lost Medicaid coverage from June of this year to July. It’s unclear how many children have been dropped since — the agency has not yet updated its August numbers.

Mississippi is one of only three states that does not have Medicaid online accounts as of January 2023, according to the Kaiser Family Foundation, though people do have the option to complete their renewal online.

According to a July press release, Mississippi Medicaid enrollment increased by 187,894 people, or 26%, from March 2020 to June 2023, bringing Mississippi’s Medicaid rolls over 900,000 people for the first time in the agency’s history.

In June, Mississippi Medicaid was set to examine the records of 67,695 Mississippians whose coverage was up for review.

It found that a little under half of those, or 29,460, were no longer eligible. According to the agency, about 60% of the people who were removed had remained insured during the pandemic because of the extended eligibility rules.

The latest data release shows that of the 75,110 Mississippians who had their eligibility evaluated in July, 22,507, or 30%, were unenrolled.

The majority of those were terminated because of “procedural reasons,” meaning they lost coverage for not returning paperwork or related reasons.

That means many of the people dropped so far could be people who are still eligible.

Alker said Mississippi’s ex-parte rate was “relatively low” — ex-parte renewals are automatic renewals, and the best case scenario during unwinding. Mississippi Medicaid spokesman Matt Westerfield said that the agency is focused on increasing those ex-parte approval rates. 

“If individuals qualify for Medicaid coverage, we’d rather make that determination without having to mail a form that they have to fill out and that a Medicaid specialist then has to process,” he said.

Combined with the high rate of procedural terminations — only 11 states have higher percentages, according to Alker’s organization — it’s cause for concern, she said, enough that she suggested Gov. Tate Reeves should step in.

“The governor should absolutely pause these procedural terminations and figure out what’s going on,” Alker said.

According to Westerfield, the Division requested permission from the Centers for Medicare and Medicaid Services on Aug. 7 for “four additional flexibilities that could help reduce procedural disenrollments while increasing ex-parte renewals.”

A letter provided to Mississippi Today by the Division shows that those “flexibilities” included permitting managed care plans to help beneficiaries submit renewal forms, renewing coverage for people whose information “is not returned or is not returned within a reasonable amount of time” and reinstating eligibility for people who were previously unenrolled more quickly. These allowances have not yet been approved, but Westerfield said the agency anticipates that soon.

People who were dropped because they didn’t submit the needed information can be reconsidered without a new application if they submit that information within 120 days of the disenrollment.

Though Mississippi Medicaid launched the “Stay Covered” outreach campaign that included postcard mailing, flyers and text and email blasts to make people aware of the unwinding process, the leader of a local health advocacy organization that has partnered with the agency previously told Mississippi Today that he doesn’t believe Mississippi Medicaid is doing enough to inform beneficiaries. Additionally, it’s not clear how many emails or letters have been disseminated — Westerfield previously did not respond to that question.

Westerfield did say the Division did not process renewals for a few months for beneficiaries in the Delta affected by tornadoes this spring, though it’s not clear if the agency is doing anything in particular to reach those people — who may be displaced — now.

The new data also reveals a growing backlog in Mississippi.

In June, about 5,000 renewals that were up for review were not completed. The new numbers show that an additional 15,000 reviews went uncompleted last month. Westerfield blamed it on the larger review group in the July reporting period compared to June.

Alker says the backlog isn’t uncommon, and it’s neither good nor bad news.

“We want states to take their time, and they still have a lot of time,” she said. States have until May 2024 to complete the unwinding process.

“But it speaks to the backlog and the system, and the fact that they don’t have enough staff to begin with in many states, including Mississippi,” Alker said. “The backlog will keep getting bigger, and that’s going to be a problem.”

And as unwinding continues and a mounting number of Mississippians are potentially without health care coverage, stress continues to mount on Mississippi’s health care infrastructure.

As Reeves and other Republican state leaders continue to oppose expanding Medicaid to the working poor, one report puts almost half of the state’s rural hospitals at risk of closure, and data from Alker’s organization shows that rural populations will be the ones most affected by unwinding.

“If there’s a big unwinding problem, it’s going to be really devastating for these rural communities,” she said.

CMS sent letters to all state Medicaid division directors last week, including Mississippi’s director Drew Snyder. Because Mississippi started disenrollments in June, CMS did not have comments about Mississippi’s procedural termination rate — they analyzed states’ May numbers in their letters.

However, the letter indicated they would continue to keep an eye on deficiencies in individual states’ unwinding processes.

“I think what was important about the letters is that CMS, this is the first time that they’ve done something publicly like this,” Alker said. “I took it as a sign that they’re stepping up their enforcement.”

As of August, almost 5 million people have been disenrolled from Medicaid nationwide, according to the Kaiser Family Foundation. The organization says up to 24 million people could end up losing coverage during the unwinding.

This article first appeared on Mississippi Today and is republished here under a Creative Commons license.