Common Medicaid Unwinding Issues

From Justice in Aging

"Advocates should be on the lookout for issues with states not properly disregarding Social Security cost of living adjustments (COLA) that took effect prior to states implementing the new eligibility standards. These issues may be more common this year as states have resumed Medicaid redeterminations after the end of the public health emergency. Read our updated Common Medicaid Unwinding Issues Impacting Older Adults: Advocacy Opportunities & Practice Tips for more information on how to identify, mitigate, and resolve issues."

Excerpt from the above linked document:

"Issue 1: Individuals receiving Supplemental Security Income (SSI) are required to complete and submit renewal packets or new applications to renew Medicaid

• SSI-linked individuals in Section 1634 states (this includes Indiana) should not be receiving forms or packets to renew Medicaid coverage because those states agreed to use SSA’s approval for SSI benefits as automatic approval for Medicaid. Therefore, SSI recipients in these states should not be receiving renewal packets, instead, the state just needs to confirm their continued receipt of SSI to renew their SSI-Medicaid.
• For non-1634 states or for individuals not receiving SSI, states are obligated to conduct ex parte reviews to determine Medicaid eligibility. Ex parte means states should be using available data sources without requiring action from the individual in their reviews of Medicaid eligibility. Individuals should receive renewal forms and requests for documentation only when ex parte data is insufficient to determine eligibility. 
• Failure to review eligibility using SSA verification or other ex parte data forces older adults and people with disabilities to complete tedious forms and submit all income and asset information. This can lead to improper terminations despite continued SSI eligibility or Medicaid eligibility. For people dually eligible for both Medicare and Medicaid, this can also result in the loss of Medicare Savings Program (MSP) eligibility and state payment of Medicare premiums and cost-sharing (see next example). 

Advocacy Opportunities: 

• Ask states to confirm their computer systems are accurately identifying SSI individuals. If a large number of SSI-eligible individuals are receiving renewal packets, advocates should encourage the state to pause redeterminations for this population until the error is resolved. 
• Even if individuals are no longer eligible for SSI, the state must still conduct redeterminations using ex parte data to determine eligibility for other Medicaid programs, like Medicaid aged, blind, and disabled and Medicare Savings Programs, prior to termination. 
• Ask states to put in place a secondary review process for any SSI-eligible individual for secondary review since this population is less likely to have change income and resources that result in loss of all Medicaid eligibility (including MSP eligibility) and the financial and health harms are so significant (see below MSP example Issue 2).

Practice Tip:

• If an individual with SSI receives a renewal packet asking them to reapply or provide extensive documentation of income and assets, contact the Medicaid agency first to provide verification that the individual has SSI. This may avoid the individual having to submit a full application when the state only needs SSI verification. Request that the agency stamp the received date on any forms or documents submitted."