In just over two weeks, the state’s Division of Medicaid will begin the daunting process of determining for the first time in three yearswhether hundreds of thousands of low-income Mississippians are still eligible for health coverage. 

As a result, Mississippians, adults and children, who have had coverage as the result of a federal pandemic-era policy of continuous enrollment could lose health insurance as soon as July, according to the division.  

Mississippi’s Medicaid division will begin examining its roughly 890,000 recipients to determine their eligibility starting April 1. But with a staff vacancy rate of 12% and an onslaught of work, national health care experts and local advocates are worried about eligible children, especially, falling through bureaucratic cracks and losing coverage.

Those who work with Medicaid recipients have a litany of concerns: from the division’s ability to effectively communicate with families known to frequently move to the low rate of automatic electronic renewals the state has done in the past. 

“It’s nothing new that parents, once they get over a very low income level, they have no coverage because the state hasn’t expanded Medicaid,” said Joan Alker, the executive director and researcher at Georgetown University’s Center for Children and Families. “What is new is we might see thousands of eligible children lose coverage during this process.”

The stakes are high. 

Mississippi children in low-income families make up more than half of the state’s overall Medicaid recipients. Some have coverage through Children’s Health Insurance Program, or CHIP. During continuous coverage, Medicaid rolls in Mississippi have increased by more than 130,000 people – 80,000 of whom are children.

The U.S. Department of Health and Human Services said as many as 15 million people nationwide could lose Medicaid or CHIP coverage. About 6.8 million people could be disenrolled even though they are still eligible, the department estimates, because of enrollees struggling to navigate the renewal processes, states unable to successfully contact enrollees or other administrative hurdles. 

On its end, the state’s Medicaid division said it’s hired 22 new workers in the past week and has 100 contractors to help manage caseloads. The biggest push from the office so far has been asking recipients to ensure their contact information and mailing addresses are up-to-date. 

“To raise awareness about redeterminations and the importance for members to update their contact information, (Mississippi Division of Medicaid) launched a Stay Covered campaign in January and invited community partners to sign up to be Coverage Champions,” spokesman Matt Westfield said in a statement. “Our Coverage Champions partners include a diverse mix of health centers and advocacy groups.”

Posts are all over Facebook. Flyers have been shared both online and in-person with scannable codes that link to an online form. 

Medicaid coverage is determined by income, but the threshold for children to still qualify in Mississippi is higher than that of their parents and other adults. 

Joy Hogge, the director of Families of Allies, a statewide nonprofit that supports children with health challenges, said her office is going to start asking every family who contacts them if they’re aware of the upcoming renewal process. 

“We haven’t had families ask questions (on their own),” Hogge said. “So, I don’t know if it’s not reaching them. I’m not sure of what the awareness level is from families being affected.” 

So far, Mississippi hasn’t published a detailed unwinding plan. The one document the division was required to upload for the federal government includes a long checklist of measures where the agency could check “already adopted” or “planning or considering to adopt.” 

But details of where the state was in the process of adding improvements wasn’t included. That makes it hard to decipher exactly what’s going on, said Garrett Hall, a policy analysis at health advocacy organization Families USA. 

Westfield said the state does plan to post a more detailed unwinding plan online once it’s ready. This is something states such as California and Arizona have already done. 

Mississippians, for example, don’t have online accounts to easily log in to Medicaid – something 48 other states have, according to KFF. In a tweet earlier this month, Mississippi Division of Medicaid Director Drew Snyder said it was something his office was testing and planned to deploy this year. 

Mississippi is taking the full  12 months allowed by the federal government to work through its redetermination process. Arkansas, for example, is planning to do the same process in only six months – something that raises major red flags for health care advocates. 

While Hall is glad Mississippi won’t rush through the process in half the time, he does point out that Mississippi doesn’t have a high percentage of “ex parte,” or automatic, renewals. The division told Mississippi Today its automatic renewal rate was 24% before the pandemic – though that’s a rate they expect to go up over the next year. 

Hall said states should hit a 50% ex parte rate at minimum. 

Using state databases – like of families who qualify for food assistance or individuals receiving unemployment – Medicaid divisions can automatically enroll people they know are still eligible. Hall said it’s the most seamless way to ensure people retain coverage who still qualify. 

“No one who is still eligible for coverage should lose it because they are subjected to a confusing and cumbersome renewal process,” Hall said. “Looking at Mississippi’s unwinding plan, they have some steps in the right direction but they need to follow through on some of those further steps.” 

Alker worries about whether notices will even reach families. Low-income families are often mobile, and may not know they need to update their address. If the letter does find them, she wonders what the language will be like and if it could be misleading. Alker pointed to a prior instance where Mississippi’s Division of Medicaid shifted enrollees’ coverage without making a public announcement. 

“Is it going to be clear that even if a parent loses coverage, their child may still be eligible?” Alker said. “Is there going to be adequate support at the call center to work through the renewal process or questions? Sometimes there are just glitches and delays due to short staffing. All sorts of things can go wrong.” 

Westfield said when the Mississippi division begins its redetermination process, it will first focus on auto-renewing benefits using state data systems for electronic verification. If someone can’t be approved this way, they will be mailed a renewal form which they will have 30 days to return to the office. 

If the Medicaid division determines someone is no longer qualified, they will receive a notice by mail explaining the decision and how to file an appeal, according to Wesftield. Their information will also be sent to the Health Insurance Marketplace, and they will be notified about their options through the Affordable Care Act. 

Michael Minor, the executive director of Oak Hill Regional Community Development Corp., has been working closely with families who qualify for Medicaid or CHIP since 2019. The initiative is called “Healthy Kids MS,” and it aims to keep kids covered and up to date on doctor’s visits.

“We see ourselves as being that unseen, invisible hand there that’s helping folks to work with the system,” Minor said. “It’s a matter of meeting folks where they are.”

That means churches, schools, and doctors offices. Volunteers will even drive forms to Medicaid offices on behalf of families with transportation struggles. Hogge and Minor both said their workers will sit on a phone call to Medicaid with a recipient if that’s the support families need.

Minor and his team of Medicaid navigators are bracing for the surge of questions – but they’re not worried.

‘We’re set up for this,” he said. “And we’re just doing what we normally do.”

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