The post-pandemic unwinding of Medicaid continues nationwide, removing millions of people from the program after a moratorium that prohibited disenrollments during COVID-19 expired.
The move marks a return to normalcy for Medicaid after a three-year period that essentially froze the program’s ability to redetermine enrollees’ eligibility every year.
The unwinding also means many Nevadans were disenrolled from the program — just under 260,000, according to the Kaiser Family Foundation’s KFF Medicaid Enrollment and Unwinding Tracker.
Here’s everything you need to know about the ongoing redetermination process for Medicaid and what you have to do if you find yourself disenrolled.
What is the Medicaid unwinding process?
The Medicaid unwinding refers to the end of the continuous enrollment policy that started in March 2020.
The policy was enacted at the start of the COVID-19 pandemic to prevent people on Medicaid and the Children’s Health Insurance Program or CHIP from losing health coverage during the public health emergency.
“We were not allowed to terminate (Medicaid coverage) unless someone requested it or passed away or moved out of state and let us know,” said Kelly Cantrelle, deputy administrator of the Nevada Division of Welfare and Supportive Services.
“No one got shut off whether they were over income or not.”
The unwinding process started in June 2023, according to Cantrelle.
Why are so many people being disenrolled by the Medicaid unwinding process?
The unwinding is causing a large number of people to be disenrolled from Medicaid due to several factors.
One is the sheer number of people who joined the program during the pandemic.
“Prior to the pandemic, 650,000 people were covered by Medicaid (in Nevada),” Cantrelle said. “At the height of the pandemic, we had close to a million — upwards of 980,000 people — so the pandemic drastically increased the numbers.”
Add the fact that Medicaid was not allowed to disenroll people over a three-year period and the result is a ballooning in the number of enrollees.
Nevada’s historical way of terminating enrollment also meant that many people, including entire families, were automatically disenrolled if confirmations were not sent on time. The state received a notice from the Centers for Medicare & Medicaid Services last September that the way Nevada did redeterminations and renewals for the unwinding needed to be changed.
“If (Medicaid coverage for) a household needed to be renewed, we would send a packet to the household and if it didn’t comply, every person in the household was terminated (from Medicaid),” Cantrelle said.
The Centers for Medicare & Medicaid Services told the state that it needed to redetermine eligibility on an individual basis instead.
So just exactly how many Nevadans were disenrolled from Medicaid during unwinding?
A total of 257,800 enrollees in Nevada were disenrolled from Medicaid during the unwinding process as of May 10, according to the KFF Medicaid Enrollment and Unwinding Tracker. Meanwhile, 568,200 Nevadans had their coverage renewed.
The numbers from the Nevada Department of Welfare and Support Services are not exactly the same as the KFF tracker, which uses a mix of state data and information from the Centers for Medicare & Medicaid Services.
Cantrelle also noted that KFF totals still include people who have since been readmitted to Medicaid or CHIP. After receiving the note from Medicaid that it needed to verify eligibility individually, DWSS reinstated nearly 160,000 people back into the program, for example.
Currently, just under 125,000 Nevadans remain disenrolled from Medicaid. Of that number:
- 77,789 were disenrolled for not responding or providing supporting documentation for their renewal.
- 22,114 were disenrolled because they were enrolled in Medicaid in another state.
- 24,459 were disenrolled because their income was too high.
Those who were making too much were referred to the Silver State Health Insurance Exchange so they could apply for insurance from the marketplace instead, according to Cantrelle.
How many Nevadans disenrolled from Medicaid have signed up for insurance on the state exchange?
So far only a small number of people who were disenrolled from Medicaid have signed up for insurance on the state exchange.
As of April 1, only 495 Nevadans referred to the state exchange by DWSS have signed up for insurance, said Russell Cook, executive director of the state exchange that runs Nevada Health Link.
Cook pointed out that the referrals from DWSS ultimately were cut down to about 12,300 because some individuals were referred multiple times. Not all of those referrals also qualified for subsidies on the exchange to lower their monthly fee, Cook added.
Although the enrollment rate has been low compared to the number of people who have been referred, the good news is that the special enrollment period for people who were referred to the exchange after being disenrolled from Medicaid to sign up at the exchange runs through Sept.30.
The deadline provides enough time for people who lose Medicaid coverage during the unwinding process.
“(We anticipate) another five months before the unwinding completes,” Cook said. “We are looking at roughly through the end of September.”
What should Medicaid beneficiaries do in response to the unwinding?
If you’re on Medicaid and concerned about losing your benefits from the unwinding process, here are some things you need to do:
Check your mail: Tens of thousands of Nevadans were disenrolled for failing to respond and provide documentation for their renewal.
“They need to watch that mail for their renewal packet,” Cantrelle said. “If something is requested from you, get it in as fast as you can.”
Respond within 60 days: If you were disenrolled for not responding or some other reason but remain eligible for Medicaid, it is important that you reach out and have your issue fixed within 60 days of losing your coverage.
“For those within that 60-day window, act now to avoid a gap in coverage,” Cook said. “Not only will they avoid a gap in coverage but (re-enrolling) will be an easier process to navigate.”
Re-enrolling within that 60-day period also means your Medicaid coverage will be backdated to the first day you initially lost coverage, which is very helpful if you have any claims at that time.
Otherwise, your coverage will start on the first day of the next month if you re-enroll past the 60-day period.
Check Nevada Health Link: This advice is for people who are no longer eligible for Medicaid. The health exchange can be a good option for affordable coverage, especially for those who qualify for subsidies that can significantly lower your monthly premiums.