Medicaid unwinding: WV among 30 states not complying with federal requirements 

Fewer than 8,000 children affected, state officials say

By: - September 25, 2023 5:58 am
A Medicaid card, two $100 bills and a stethoscope sit on top of an American flag.

As states return to pre-pandemic eligibility rules for Medicaid and CHIP, up to 10,000 West Virginia children may have wrongly lost coverage. (Getty Images)

As states return to pre-pandemic eligibility rules for Medicaid and the Children’s Health Insurance Program, up to 10,000 West Virginia children may have wrongly lost coverage because the state is conducting automatic renewals for the program at the household level instead of individually, federal officials said Thursday. 

West Virginia was not among the 23 states that attested to doing the automatic renewals at the individual level, in compliance with federal requirements, according to a preliminary assessment by Centers for Medicare & Medicaid Services. Fewer than 10,000 West Virginia children are affected by the issue, CMS said. 

Automatic renewals, also called ex parte renewals, rely on available financial information for the recipient rather than sending them a renewal form to complete. 

CMS wrote a letter to state directors Aug. 30 that some states were doing automatic renewals for CHIP and Medicaid on the household level instead of individually. 

“As a result, while a state may have sufficient information during the ex parte process to renew Medicaid or CHIP coverage for some individuals in a multi-member household, states are sending renewal forms requesting information for all household members, and, if the renewal form is not returned, states are disenrolling all individuals in the household, including those who should have been determined to be eligible through the ex parte process,” the letter stated. “As discussed in more detail below, these actions violate federal renewal requirements and must be addressed immediately.”

Children are eligible for Medicaid and CHIP at higher income levels than adults. By renewing the recipients at a household level, states could be disenrolling children who are still eligible for the programs. 

During a legislative interim meeting earlier this month, Cindy Beane, Commissioner for the West Virginia Bureau for Medical Services, told lawmakers the state would submit a corrective action plan. 

“We have found that there are some households where the household is over income, and it’s not looking at the child’s income, which is of course going to be zero at that age of the child….” Beane said.

“This is something that came up last week with CMS,” she said. “We have less than 8,000, it will probably be less once we get the exact number of those individuals. We will be going back and re-determining their eligibility.”

For three years during the COVID-19 pandemic, states were prohibited from removing people from Medicaid and CHIP 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 as part of a year-long “unwinding” process. 

According to the latest data from the state, for the months of April through August, the state removed more than 100,000 people from Medicaid or CHIP. 

Craig Robinison, executive director of Cabin Creek Health Systems, told West Virginia Watch in July some people find out about their coverage being gone only when they show up to health care appointments. He said losing coverage can create health problems.

“It can be a real disruption of care [when] people lose the benefit,” he said. “They can’t buy the drug they need that month, or they can’t receive another kind of treatment, or they’re in the midst of a cancer treatment regimen — it can be very serious.”

In August, the federal government raised concerns over the high number of West Virginia residents being removed from the programs because of procedural issues like not completing a renewal form.

Beane, speaking to lawmakers, emphasized that eligible Medicaid and CHIP recipients can re-enroll in the program at any time if they were removed. 

“There isn’t a certain enrollment period, you can come onto Medicaid at any time,” Beane said. “So even if you’ve missed your letter, you’ve missed the [Medicaid care management] calling you, you’ve missed all the different text messages and you roll up into your doctor’s office, we can make sure that that appointment is covered with that.”


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Lori Kersey
Lori Kersey

Lori Kersey is a reporter with a decade of experience reporting in West Virginia. She covers state government for West Virginia Watch.