Feds raise concerns about West Virginians losing health care during Medicaid, CHIP unwinding 

As Medicaid and the Children Health Insurance Program return this year to pre-pandemic era rules, the high number of West Virginians removed because of procedural issues — like not returning a renewal form — has raised concerns with the federal government that eligible people are losing coverage.

A letter to state Medicaid Commissioner Cindy Beane last week from Anne Costello, deputy director of the federal Centers for Medicare and Medicaid, noted that in May, 24% percent of the 47,329 people up for renewal of CHIP or Medicaid were removed for a procedural reason rather than because they were no longer eligible for the programs. 

“This high percent raises concerns that eligible individuals, including children, may be losing coverage,” Costello wrote. “Federal regulations … require the agency to continue to provide Medicaid to eligible individuals until they are found to be ineligible.”

Additionally, callers to West Virginia’s Department of Health and Human Resources customer service line wait on average nine minutes. The call centers have a 19% average call abandonment rate, the letter states. 

“Persons of color are less likely to have broadband or internet access, or transportation or jobs that permit the time and access needed to meet with Medicaid enrollment staff in person, and therefore may rely more on call centers,” Costello wrote. “State Medicaid agencies have independent obligations under federal civil rights laws to ensure eligible individuals continue to have access to Medicaid and CHIP as states return to normal eligibility and enrollment operations.”

Regular Medicaid and CHIP rules require the state to send annual renewal letters to program participants. 

For three years during the COVID-19 pandemic, however, states were prohibited from removing people from the programs in order to receive enhanced funding from the federal government. In that time, West Virginia’s Medicaid enrollment grew 30% — from 504,760 in March 2020 to 656,269 in December 2022, according to DHHR.

With the federal public health emergency ended, states began sending renewal letters to program participants beginning in April. 

In West Virginia, more than 60,000 people were removed from the programs during the first three months of the so-called “unwinding” process, which is expected to take a full year.

Of those, 36,505 were removed from the program for a procedural reason. Renewals were not completed for another 2,175. Another 25,308 were removed because they were deemed ineligible for the programs.

Craig Robinson, director of Cabin Creek Health Center, a federally qualified health center, told West Virginia Watch at least some people who were removed found out only when they tried to access health care.

According to DHHR, the state removed 20,483 people from Medicaid or CHIP in July, including 14,611 who were removed because of a procedural issue. Of those removed because of a procedural termination, 5,849 were children under age 19.

In the letter, CMS said that states should ensure all states are taken to streamline or automate renewals.

If that’s not possible, the federal government wrote, states should send renewal forms to all beneficiaries before ending coverage for procedural reasons.

In response to a reporter’s question, a CMS spokesman said the federal agency wrote letters to all states and the District of Columbia outlining concerns the agency has based on state data about equitable access to assistance and the ability to renew Medicaid and CHIP coverage.

“CMS takes our monitoring and oversight role incredibly seriously and is doing everything in our power to help states to go above and beyond the minimum requirements to keep people covered,” the spokesperson said.

Where states do not comply with federal requirements, the agency is taking action, the spokesperson said. 

“This action can include requiring states to pause terminations, reinstate coverage, adopt strategies to support individuals through the renewal process, and address systems issues — and if states don’t, they will risk losing the enhanced federal funding,” the agency said. 

West Virginia received enhanced federal funding of 6.2% or around $50 million per quarter from 2020 through March 2023, and smaller increases of 5% this spring, 2.5% this summer and are scheduled for 1.5% this fall, DHHR spokeswoman Jessica Holstein said.

Holstein said DHHR has communicated with providers and the public for more than a year about the need for recipients to ensure their contact information is updated with the state, to check their mail for a renewal letter and to submit their renewal letter as quickly as possible. 

The state has also taken a series of steps to reduce the number of procedural terminations, including contacting all members with two phone calls, an email, and the mailed renewal form the month before they are due for renewal, and a mailed termination letter and phone call before the person is removed for a procedural reason, Holstein said. 

Managed care organizations also to outreach for their members before closures, Holstein wrote. 

The state has also removed some barriers to streamlining renewals for recipients whose eligibility is based on income, and has a CMS-approved plan to start streamlining renewals for those whose eligibility is not based on income later this year.

From April through July, Holstein said, 57,600 people applied for Medicaid and CHIP, including 876 who applied by phone through DHHR’s Customer Service Center.