The Households First Coronavirus Response Act (FFCRA), enacted at first of the coronavirus pandemic, requires states to offer steady enrollment to Medicaid enrollees till the top of the month by which the general public well being emergency (PHE) ends with the intention to obtain enhanced federal funding. Throughout this time, states usually can’t disenroll folks from Medicaid, which has prevented protection loss and churn (transferring off after which again on to protection) amongst enrollees throughout pandemic. The PHE is presently in impact by mid-April 2022 and the Biden administration has mentioned it’s going to give states 60 days’ discover earlier than the PHE ends. Since that discover was not issued in February 2022, it’s anticipated the PHE can be prolonged once more, though there’s uncertainty over how lengthy the extension will final.
As soon as states resume redeterminations and disenrollments on the finish of the PHE, Medicaid enrollees who moved inside a state throughout the pandemic however are nonetheless eligible for protection are at elevated danger of being disenrolled if their contact data is old-fashioned. Many state Medicaid packages are closely reliant on the mail for speaking with enrollees about renewals and redeterminations, together with requests for data and documentation. States can disenroll people who fail to answer these requests. We analyzed federal survey knowledge for 2020 and located:
- Roughly 1 in 10 Medicaid enrollees (9%) moved in-state in 2020. A a lot smaller share, simply 1%, moved to a special state within the U.S. People that transfer throughout the similar state could proceed to be eligible for Medicaid, whereas a transfer out of state would make them now not eligible for Medicaid protection of their earlier state. Shares of Medicaid enrollees transferring inside a state has trended downward in recent times, however tendencies might have modified in 2021, as extra folks grew to become vaccinated in opposition to COVID-19 and the nationwide eviction moratorium was lifted in August 2021.
- Amongst these coated by Medicaid, younger adults and single-parent households with youngsters had been extra prone to transfer inside a state than different teams. Amongst Medicaid enrollees that moved throughout the similar state in 2020, half (50%) moved for housing-related causes and 28% moved for family-related causes.
States can take plenty of actions to replace enrollees’ addresses and different contact data to attenuate protection gaps and losses for eligible people after the top of the PHE, notably for people who could have moved inside a state. These actions embrace conducting direct outreach to enrollees, partnering with managed care organizations and different stakeholders in outreach efforts, creating clear insurance policies for returned mail, and checking out there knowledge sources for extra up-to-date contact data. A current survey of states discovered that almost all states (46) had been taking proactive steps similar to these to replace contact data, though fewer (35) are following up on returned mail. Cautious monitoring and oversight of state progress throughout the unwinding interval might present data to stop faulty terminations of protection.
To grasp who could also be at elevated danger of dropping Medicaid protection due to out-of-date contact data, this transient analyzes knowledge from the Present Inhabitants Survey’s (CPS) Annual Social and Financial Complement (ASEC) from March 2021 to look at the share of Medicaid enrollees who moved inside a state (and subsequently usually tend to stay eligible for Medicaid in the identical state) in 2020 and the demographic traits of these people. It additionally examines tendencies in residential mobility over time and discusses methods states can undertake to attenuate protection losses amongst these people.
The information utilized in our evaluation replicate mobility patterns throughout 2020 and had been collected earlier than necessary occasions, similar to when the COVID-19 vaccine grew to become broadly out there to all adults and the top of the nationwide eviction moratorium, that will have affected the quantity of people that moved extra lately. Moreover, our evaluation focuses on non-elderly Medicaid enrollees (as a result of enrollees ages 65 and older probably have Medicare as their main supply of protection) and so we confer with non-elderly Medicaid enrollees merely as “enrollees” for the rest of this transient. See the Strategies field on the finish of this transient for extra particulars concerning the evaluation and limitations.
What will we find out about Medicaid enrollees who moved in-state in 2020?
Roughly 1 in 10 Medicaid enrollees (9%) moved in-state in 2020. A a lot smaller share, simply 1%, moved to a special state within the U.S., which might make them now not eligible for Medicaid protection of their earlier state. The share of enrollees transferring throughout the similar state was barely increased in comparison with people who find themselves not enrolled in Medicaid (8%), though the share was not considerably completely different for non-enrollees who moved to a special state in 2020 (2%). These estimates are primarily based on CPS ASEC knowledge, which asks survey respondents whether or not they lived in the identical home one 12 months in the past. One limitation of this strategy is that the CPS ASEC knowledge don’t establish individuals who have moved a number of instances over the course of the 12 months, reflecting extra extreme housing instability that’s extra frequent amongst low-income populations. Moreover, these knowledge don’t establish non permanent (or seasonal) strikes throughout the 12 months, similar to transferring in with household or associates, which grew to become extra frequent in 2020 and early 2021 in response to the pandemic.
Amongst these coated by Medicaid, younger adults and single-parent households with youngsters had been extra prone to transfer inside a state than different teams (Determine 1). In 2020, roughly 11% of younger adults (ages 19-34) with Medicaid protection moved in-state in comparison with 8% of kids and seven% of adults ages 35-64 with Medicaid. Among the many completely different household varieties analyzed, enrollees who reside in single-parent households had been the almost definitely to maneuver in 2020 (12%), whereas enrollees dwelling in multi-generational households had been among the many least prone to transfer (6%). Once we in contrast residential mobility by race/ethnicity, a smaller share of Hispanic folks enrolled in Medicaid moved inside state in 2020 (7%) in comparison with White folks (9%), whereas the shares of Black folks (9%) and other people of different races (9%) who moved weren’t completely different in comparison with White folks.
Amongst enrollees that moved throughout the similar state in 2020, half (50%) moved for housing-related causes and 28% moved for family-related causes (Determine 2). Housing-related causes embrace wanting a greater dwelling and/or neighborhood, wanting cheaper housing, foreclosures or eviction, and different unspecified housing-related causes. Household-related causes embrace establishing one’s personal family, modifications in marital standing, and different unspecified household causes. Usually, Medicaid enrollees had been extra prone to transfer in-state for family-related causes in comparison with individuals who weren’t enrolled in Medicaid (28% vs. 24%) and had been much less prone to transfer in-state for job-related causes in comparison with individuals who weren’t enrolled (9% vs. 12%). Medicaid enrollees and non-enrollees each moved throughout the similar state for housing-related or different causes at about the identical price. When in comparison with the rationale folks moved in 2018 (the latest measurement 12 months earlier than the pandemic), Medicaid enrollees’ causes for transferring have stayed comparatively regular regardless of financial disruptions in 2020 associated to the pandemic.
The share of Medicaid enrollees transferring throughout the similar state has declined barely in recent times, from 15% in 2014 to 9% in 2020, though that pattern might change in 2021 and 2022 (Determine 3). Declining shares of Medicaid enrollees transferring throughout the similar state since 2014 mirrors nationwide tendencies of fewer folks transferring over time. Nevertheless, the share of Medicaid enrollees transferring has decreased quicker in comparison with non-enrollees in recent times. Whereas the pandemic has raised issues about financial disruptions and housing instability amongst low-income populations, the information for 2020 point out that residential mobility amongst each Medicaid enrollees and non-enrollees largely adopted pre-pandemic tendencies. Nevertheless, these tendencies might have modified in 2021, as extra folks grew to become vaccinated in opposition to COVID-19 and the nationwide eviction moratorium was lifted in August 2021.
How can states reduce protection losses amongst eligible enrollees who transfer?
With the continual enrollment requirement in place throughout the PHE and the prohibition on disenrolling people from Medicaid, states might not be speaking frequently with enrollees and, consequently, could have outdated contact data for many who have moved throughout the state throughout the previous two years. When the PHE ends and states resume routine redeterminations and disenrollments, some enrollees could also be prone to dropping protection just because they don’t obtain notices or renewal data. As states put together to renew regular operations, they’ll take plenty of actions to replace enrollee addresses and different contact data to attenuate protection gaps and losses for eligible people. The Facilities for Medicare and Medicaid Providers (CMS) has developed a broad set of coverage and operational methods states can undertake to take care of steady protection for eligible people, together with particular methods for updating contact data and lowering returned mail:
Conduct communication campaigns by mail, textual content, and e-mail to encourage enrollees to offer up to date contact data. States can ship periodic notices throughout the PHE to remind enrollees to replace their contact data. To the extent states have various contact data, they’ll additionally attain out by automated cellphone calls, textual content messages and emails. And, to make sure that enrollees are reminded after they proactively attain out to the Medicaid or different social providers companies, states can replace name middle scripts to request up to date contact data at first of the decision and may add alerts to Medicaid, CHIP, and social providers web sites.
Companion with managed care organizations (MCOs), community-based organizations, utility assisters, and suppliers in outreach efforts. To broaden the attain of outreach efforts, states can work with MCOs, group companions, and suppliers to strengthen messages and remind enrollees to offer up to date data. Enrollees are used to receiving communication from MCOs and could also be extra probably to answer reminders from them. Navigators and authorized utility assisters may also be efficient companions as a result of they frequently replace contact data throughout interactions with purchasers. States can choose to simply accept up to date data from these entities, or within the case of MCOs require that they share this data however ought to develop insurance policies for verifying up to date data with enrollees.
Develop clear insurance policies for following up on returned mail that may embrace checking out there knowledge sources and contacting enrollees through cellphone, textual content, or e-mail. When mail is returned and no forwarding tackle is supplied, states are inspired to test out there knowledge sources, together with america Postal Service (USPS) Nationwide Change of Tackle Database, the Supplemental Diet Help Program (SNAP), Short-term Help for Needy Households (TANF) or different packages, and/or contact data from MCOs. They’ll additionally contact enrollees through cellphone, textual content, or e-mail to acquire up to date mailing addresses.
To arrange for the top of the PHE and steady enrollment requirement, most states (46) are taking proactive steps to replace enrollee addresses, though fewer (35) are following up on returned mail as of January 2022. Actions to replace addresses embrace conducting outreach to enrollees, checking different packages for up to date addresses, and dealing with managed care plans and suppliers to replace tackle data. States that observe up on returned mail are almost definitely to name or e-mail enrollees utilizing data on file after they obtained returned mail from a discover despatched to an enrollee.
As states resume redeterminations and disenrollments on the finish of the PHE, proof means that it’s unlikely that giant proportions of enrollees can be now not eligible for Medicaid as a result of they moved out of state. When requested to foretell the first causes folks will lose protection after the continual enrollment requirement is lifted, few states (3) recognized transferring as a key driver of disenrollments, and all cited different causes, together with elevated revenue or different modifications in circumstances, along with transferring. Whereas the variety of Medicaid enrollees transferring throughout the similar state didn’t enhance throughout the first 12 months of the pandemic, the 9% of Medicaid who moved in-state in 2020 nonetheless quantities to a major variety of enrollees whose contact data is extra prone to be old-fashioned and who’re at elevated danger of dropping protection as states unwind the continual enrollment requirement. Additionally it is potential that, because the pandemic continued into 2021 and 2022, the cumulative variety of Medicaid enrollees who moved has elevated as effectively. States with comparatively massive numbers of disenrollments resulting from returned mail could point out faulty terminations, as returned mail alone doesn’t essentially point out a change in financial circumstances that impacts eligibility, particularly when comparatively few enrollees transfer out of state (roughly 1% of enrollees in 2020). Cautious monitoring and oversight of state progress throughout the unwinding interval might present data to stop faulty terminations of protection.
|We analyzed knowledge from Present Inhabitants Survey’s (CPS) Annual Social and Financial Complement (ASEC) from March 2021, 2019, 2017, and 2015. These knowledge present data on who moved throughout the earlier 12 months (2020, 2018, 2016, and 2014, respectively). Our evaluation focuses on individuals who had Medicaid protection sooner or later throughout the 12 months and who moved throughout the similar state (transferring out of state would imply that the enrollee now not qualifies for Medicaid protection within the earlier state). We exclude enrollees ages 65 and older since almost all would qualify for Medicare and are much less prone to lose their main supply of protection. Youngsters underneath age 1 are additionally excluded as a result of the CPS ASEC questions on transferring as of March of the earlier 12 months aren’t relevant to respondents underneath age 1. Our evaluation additionally focuses on people who moved throughout the US. Whereas our evaluation features a small quantity of people that have moved from exterior the U.S. (i.e., from a US territory or a international nation), we don’t embrace these people in our counts of people that moved in-state or to a special state. For the March 2021 CPS knowledge (and never for earlier years), we analyzed variations in chosen demographic teams, together with age group, household sort, and race/ethnicity. We additionally analyzed the share of individuals transferring inside state by intercourse, city/rural (utilizing metropolitan statistical areas as a proxy), and international born, however we didn’t discover important variations between these teams and so aren’t proven in Determine 2. All variations reported on this transient are measures on the p < 0.05 degree.
The evaluation focuses on people and makes use of particular person weights, which is necessary for decoding our findings on demographic teams. For instance, though youngsters will usually transfer with adults, the distinction between youngster enrollees and older enrollees displays conditions the place adults don’t reside with youngsters or, in some instances, youngsters (particularly these aged 18) who don’t reside with adults. In different households, the youngsters could also be enrolled in Medicaid however their dad and mom aren’t, or there could possibly be extra youngsters enrolled in Medicaid than adults (or vice versa). In analyzing household sort, we take into account the kind of household for every particular person. For instance, whereas we excluded enrollees ages 65 and older from our evaluation, youngster enrollees who reside with their dad and mom and grandparents are thought of to reside in multi-generational households.
We carried out a robustness test of our findings by evaluating the share of individuals transferring in-state as recognized within the CPS ASEC versus the American Neighborhood Survey (ACS). We in contrast findings for Medicaid enrollees and non-enrollees ages 1-64, utilizing knowledge collected within the March 2019 CPS ASEC pattern and the 2019 ACS pattern. Usually, the p.c of individuals transferring in-state over the previous 12 months had been barely decrease within the March 2019 CPS ASEC pattern (11% of enrollees and eight% of non-enrollees) in comparison with the 2019 ACS pattern (13% of non-enrollees and 11% of non-enrollees). We might anticipate some variations resulting from completely different and knowledge assortment strategies and timing between CPS and ACS, and so the distinction of two or 3 proportion factors appeared fairly small.
Our findings have necessary limitations. First, the CPS ASEC pattern doesn’t inform us when an individual moved. So, we have no idea whether or not the particular person was enrolled in Medicaid earlier than, throughout, or after the transfer. Moreover, we have no idea what number of instances an individual moved and, relying upon timing, non permanent strikes might not be captured. Second, the newest CPS knowledge used right here solely present knowledge for 2020, however the financial impacts of the pandemic have lasted for much longer, together with when the federal authorities lifted the nationwide eviction moratorium in August 2021.