During the past year the Department of Health and Welfare has worked to make sure that those eligible for health insurance through Medicaid remain enrolled. One of our chief concerns through that process has been to keep eligible children covered—a concern shared by our federal partners in a letter to Gov. Brad Little this week.

Medicaid provides health insurance coverage to eligible low-income adults, children, pregnant women, elderly adults, and people with disabilities. Normally, federal regulation requires states recertify eligibility of Medicaid enrollees annually. 

During the COVID-19 pandemic, enrollees could generally not be disenrolled even if they became ineligible, such as earning above the income threshold. Federal law temporarily required states to maintain Medicaid coverage for adults and children unless they died, moved out of state, or asked to be removed. This was called Medicaid Protection.

As the pandemic progressed, even though states could for the most part not disenroll members from Medicaid, we ran a series of tests of all automated renewal processes to simulate the end of Medicaid Protection. This ensured that our eligibility determinations would be accurate and, for those found ineligible, our electronic hand-off to the state-based exchange would work. The goal: help everyone find the coverage they need and qualify for.

That temporary pause on continuous eligibility for all enrollees ended this year. States submitted their “unwinding” plans to verify enrollee eligibility and continue coverage for eligible participants. Idaho’s plan prioritized enrollees, such as first processing renewals for enrollees who, based on available data, appeared no longer eligible. Idaho’s unwinding plan was approved and subsequently executed. 

Meanwhile, as soon as the department learned that the pause on disenrollments would end beginning April 2023, we began reaching out to Idahoans and community partners and going through records to figure out who qualifies for health insurance through Medicaid, and who does not. Doing so accurately and efficiently has been a top priority. Making sure that Idaho children who qualify remain on Medicaid has been of utmost importance.

Reexamining eligibility has been a large, complex and important undertaking that DHW has taken very seriously. Here are some examples of what we’ve done to try to ensure those who qualify remain covered:

• Staff were and are available to support all eligibility questions and complete reassessments to ensure accurate and timely coverage is provided. An individual can come into a field office, call, or go online to our mobile friendly application, Idalink, to check eligibility and, if needed, will receive coverage retroactively as far back as 90 days. 

• Idaho provides continuous coverage for kids. This means, once a child is enrolled in Medicaid, that child’s coverage will continue for one full year, even if during the course of that year the child becomes ineligible. Starting in January, this will be required for all states. In Idaho we’ve been doing it since 2020, long before it was required.

• We reviewed all our processes to ensure accurate outcomes. 

• We partnered with federally qualified health centers (FQHCs) that serve Medicaid participants to conduct targeted outreach to ensure families were aware of the need to provide updated information for redetermination efforts. 

• Multiple outreach efforts were made to Medicaid members to inform them of the end of continuous enrollment and the need to update their information, including traditional mail, email, and text messaging.
• We’ve specifically coordinated with Idaho tribes to conduct onsite redetermination efforts to ensure continuity of coverage for eligible tribal members. We also met with multiple advocate groups like Voices for Children, Office on Aging, Idaho Health Care Association, hospitals, and food banks. 

• We ran multiple social media campaigns highlighting the end of continuous enrollment and urging enrollees to contact us.

Along the way our federal partners provided updated direction with clarifying guidance, requiring states to review existing processes to ensure accurate coverage was being provided during the unwinding process. 

Upon receiving this guidance, department staff immediately took action. We paused procedural closures and pivoted to review and adjust processes and systems accordingly. As a result, 18,000 individuals, 6,000 of whom were kids, had their coverage reinstated. 

Despite our outreach efforts aimed to keep eligible Idahoans covered under Medicaid, many previously enrolled Idahoans did not respond and were removed from the Medicaid program. Our latest data shows 51,000 children have been removed from Medicaid. While this number is 10% lower than our federal partner claims, even 1 eligible child removed is one too many.

We appreciate the concern expressed regarding loss of coverage for Medicaid participants in Idaho and share the goal of ensuring qualifying individuals, including children, remain eligible for Medicaid. 

We know that we’ve taken the appropriate steps over the last nine months to make sure qualifying children and adults get and maintain the health insurance coverage they need. The department has cooperated with federal and state partners to complete the unwind of continuous enrollment in an accurate, efficient and compliant manner. On two occasions, we paused our process to ensure that eligible Idahoans remained covered. 

Ultimately, Idaho followed the law, federal guidance, and our federally approved plan to complete our unwinding work.  Most other states are still in process, with some just beginning. As they complete their unwinding activities, it will be interesting to see how the numbers compare. 

In Idaho, anyone can apply or reapply for Medicaid at any time. If you or someone you know needs health insurance, please contact DHW at 877-456-1233 to see if you qualify.