Medicaid rolls decline as state begins checking eligibility for first time in 3 years

For three years, Mississippi experimented with a de facto Medicaid expansion. The state added over 187,000 people to the rolls as a COVID-era policy required it to stop checking eligibility for benefits. Now, in the first month of restored eligibility determinations, 44 percent of reviewed enrollees were found ineligible.

In April, the Mississippi Divison of Medicaid (DOM) began checking medicaid recipients’ eligibility again after a three-year hiatus. DOM reviewed 67,695 beneficiaries with June renewal dates. The review found that roughly forty-four percent, over 29,000 enrollees, were no longer eligible to be on Medicaid.

DOM disenrolled those individuals from the program. Over the next year, tens of thousands more are expected to be determined ineligible and non-renewed. DOM explained “total enrollment is expected to continue to decline as redeterminations continue.”

Between March of 2020 and June of 2023, Mississippi’s Medicaid rolls exploded upward, adding over 187,000 people. The de facto Medicaid expansion came about not as a byproduct of changing income eligibility standards. Those have remained steady.

The growth was also not a result of declining employment or wages. The state’s unemployment number is near a record low and wages went up as inflation tightened the labor market.

No, the rapid expansion of people receiving Medicaid is much easier to explain. For the last three years, states across our country simply stopped checking to see if the people enrolled were actually eligible.

They did so not only with the blessing of the federal government, but as part of a mandate from the federal government during the pandemic.

“Continuous Coverage” During COVID

In March of 2020, Congress increased federal Medicaid payments to help states deal with the COVID outbreak. However, for states to receive the increased funding they were required to stop periodic eligibility reviews for enrollees.

This policy created what is known as “continuous coverage.” This meant, once someone was on Medicaid during that time period, they could not be removed, regardless of income level.

A sizable increase in Medicaid rolls resulted all across the nation.

In Mississippi, Medicaid rolls climbed 716,896 in March of 2020 to 904,590 in June 2023, according to DOM.

In late May, the Congressional Budget Office estimated that 15.5 million people will be removed from the rolls over the next two years as states begin checking for eligibility, again. That’s roughly 20 percent of the 93 million Americans on Medicaid.

The Centers for Medicare and Medicaid Services (CMS), a government agency that oversees the health care programs, estimates $99 billion in improper Medicaid payments occurred in 2021.

Total Medicaid expenditures in Mississippi, which include both state and federal funds, increased from $5.92 billion in FY 2019 to an estimated $7.2 billion in FY 2023.

Checking Eligibility, Again

In December of 2022, Congress passed the Consolidated Appropriations Act (CAA) which required states to begin redetermining eligibility of Medicaid members. As of April 1, Medicaid recipients were required to renew for eligibility. The federal government also began reversing its COVID-era increases in Medicaid payments in April.

In a statement released this morning the Mississippi Division of Medicaid explained its progress toward redetermining eligibility:

In April, DOM initiated reviews for 67,695 beneficiaries with June renewal months. Approximately 56% of the beneficiaries in the June review month retained coverage. Of the more than 29,000 who were disenrolled, at least 60% were individuals whose coverage had previously been extended because of the special eligibility rules during the PHE.

The statement from DOM said the figures were being submitted to the Centers for Medicare and
Medicaid Services (CMS) “reflecting the first month of eligibility renewals that have been initiated as part of a yearlong, federally mandated effort for state Medicaid programs to restore regular eligibility operations following the end of the continuous coverage provision that was in effect during the COVID-19 Public Health Emergency (PHE).”

“This federal requirement during the PHE prevented DOM from removing most ineligible individuals from Medicaid beginning in March of 2020. DOM resumed eligibility determinations on April 1, 2023, in compliance with the requirements of the Consolidated Appropriations Act, passed by Congress and signed by President Biden in December.”