If you receive health care coverage in Colorado through Medicaid, you might be at risk of losing it in the coming months. States across the country have begun checking everyone’s Medicaid eligibility as the federal response to the COVID-19 pandemic continues to unwind. Approximately 10 states have begun removing people from Medicaid, and Colorado is readying to do its own review.

Exact numbers vary from one source to another, but the Kaiser Family Foundation (KFF) estimates that about 20% of Coloradans—approximately 1.4 million—receive some Medicaid benefits. KFF says the vast majority of beneficiaries (roughly 80%) are adults and children, but fully one-half of Colorado Medicaid spending is for the elderly and those with disabilities. According to KFF, just over 60% of the state’s nursing home residents are covered by Medicaid.

Unknown numbers of ineligible enrollees were kept on the Colorado Medicaid program

What is triggering this Medicaid eligibility review? At the beginning of the pandemic, the federal government declared a public health emergency and began providing substantial amounts of money to states, agencies, and individual people to help cope with various impacts of the pandemic. The Families First Coronavirus Response Act (FFCRA) enacted by Congress in 2020 included a requirement that Medicaid programs keep people “continuously enrolled” through the end of the month in which the COVID-19 public health emergency ends. Understandably, Medicaid enrollment has grown substantially in the interim. In exchange for enhanced federal funding and due to FFCRA requirements, Colorado and most other states essentially put Medicaid eligibility review on hold. This meant in some cases that people were not removed from the program even if they no longer qualified.

As extra funding stops, Medicaid eligibility reviews start

Anyone who enrolled in Medicaid at some point in the past couple of years has stayed there, unless they moved, died or voluntarily withdrew. But as the public health emergency ends—which is now projected to formally happen in mid-May—the extra funding will stop, and states will resume reviewing their Medicaid rolls for who should and shouldn’t continue to receive the benefits. An estimate by the state’s Medicaid eligibility division director projects that over 550,000 Coloradans will warrant having their eligibility reviewed. This does not mean they will all become ineligible, but that’s how many the state has identified as potentially no longer qualifying due to one criterion or another. Kaiser Health News, for instance, has reportedly concluded that 40% of this group is at risk because of their income level being too high.

States must have proper disenrollment plans

As part of the Consolidated Appropriations Act of 2023, signed into law on December 29, 2022, Congress set an end date of March 31, 2023 for the Medicaid continuous enrollment provision, and phases down the enhanced federal Medicaid matching funds through December 2023. As states resume disenrollments, they must meet certain reporting and other requirements during the unwinding process. They must, for example, develop operational plans for how they will approach the unwinding process, how they will prioritize renewals, how long the state plans to take to complete the renewals as well as the processes and strategies the state is considering or has adopted to reduce inappropriate coverage loss during the unwinding period.

Reports say that once the public health emergency ends in May, states will have 14 months to clear their rolls, though the funding enhancement will end once the emergency does. So states are expected to move as promptly as possible to reduce their Medicaid expenses. Tracy Johnson, Colorado’s Medicaid director, has reportedly said the state has budgeted for this transition.

Connect for Health Colorado prepared to fill the gaps

Colorado’s Medicaid program is partnering with Connect for Health Colorado, which runs the state’s health insurance exchanges, to transition ineligible people from Medicaid to the exchange. Many of those who are found to be ineligible for Medicaid will likely still qualify for substantial assistance through Connect for Health. A spokesperson said Connect for Health would use social media, emails and a team of brokers and other advisors to help transition people from Medicaid to the exchanges. Johnson noted that if the transition goes well, the number of uninsured in Colorado should hold fairly steady. But if it doesn’t, Colorado could see its uninsured rate increase for the first time in a decade.

Coloradans who are on Medicaid are urged to ensure their addresses are updated and current, so the correct information and enrollment information can find them. Enrollees should also reply to any messages they receive from the state, officials said.

For further developments on Medicaid Eligibility . . .

AgeWise Colorado will make every effort to keep you updated on pertinent developments in this Medicaid transition process. Check our website regularly for such news.