Nearly 300,000 people have been disenrolled from Nevada Medicaid following the end of a pandemic-era policy that kept people continuously enrolled, state lawmakers learned Thursday, and an additional 45,000 may lose coverage next month.
Those numbers are “more than we ever anticipated,” Nevada Medicaid Administrator Stacie Weeks told legislators on the Interim Finance Committee, and could bring financial problems to the program, which is paid for with both federal and state funds.
Eligibility redeterminations were supposed to begin nationwide in April 2023. But Nevada and a majority of states experienced technical issues, delaying the “unwinding” for six months in the Silver State. Nevada Medicaid expects to complete the process next month. That dropoff, combined with higher health care costs and a lowering of the percentage of those costs paid by the federal government, are expected to result in higher costs to the state.
“If people are coming off the program, (you might think) that should mean you’re going to spend less, but unfortunately that’s not the case,” said Weeks, noting that nearly half of those disenrolled had not gone to a medical provider or had a claim in the last year. “What we’re seeing (affected) is that risk pool, which was balanced with health non-utilizers and high utilizers, some of our most costly members. We’re seeing a smaller risk pool and it’s a higher risk pool.”
As a result, metrics like ‘cost per eligible member’ have rapidly risen.
“We are seeing caseloads go up 20%,” said Weeks. “That’s very concerning because that’s a lot of money.”
Weeks said she is hoping that after the “unwinding” is complete people will re-enroll in Medicaid and bring total numbers closer to 700,000 to 800,000 people.
Procedural disenrollment — that is, disenrollment for things like inaction or paperwork issues rather than ineligibility — has been a concern among administrators and health care advocates since the unwinding process began. A KFF study released in April found that nearly a quarter of adults who were disenrolled reported having no insurance. About half of those surveyed had re-enrolled in Medicaid after being disenrolled.
Weeks said the Division of Health Care Financing and Policy, which houses Nevada Medicaid, is working with the Division of Welfare and Supportive Services and Nevada Health Link on community outreach to ensure eligible Nevadans get and stay enrolled.
“I think a lot of people don’t understand,” said state Sen. Dina Neal (D-North Las Vegas). “Then you blame the government. ‘Oh, they took my insurance away.’”
Neal urged the program administrators to make informational materials available to state lawmakers to try and get the word out.
If enrollment doesn’t go back up, Weeks warned lawmakers, “we will need to be updating you all, and the governor, and everyone, as we move forward on the cost of our program.”
Nevada is not alone in seeing more Medicaid disenrollments than anticipated. Disenrollment nationwide has surpassed initial projections made by the federal government.
For now, Nevada Medicaid’s budget looks flush. Weeks appeared before the IFC seeking approval to rollover nearly $230 million from the most recent fiscal year, which ended June 30, to the current fiscal year, which began July 1.
“I think I will need every penny of that to pay for increased cost because of the unwind,” said Weeks.
Weeks said there were other contributing factors to Nevada Medicaid’s budget uncertainty, including an unprecedented nationwide cyberattack earlier this year that affected states’ ability to process some claims from providers. Nevada Medicaid estimates $15 million in payments could have gone out but have been delayed because of issues related to that cyberattack.
Additionally, Nevada Medicaid’s budget has not fully felt the impact of provider reimbursement rate increases passed by the Legislature last year, she said.
“It takes us 6 to 9 months after you pass a bill to implement,” explained Weeks. “On our end, we can’t see the true impact because we don’t see provider claims until 6 months later sometimes.”