Over the past two years, enrollment in the state’s Medicaid program, Health First Colorado and Colorado’s Children’s Health Insurance Program (CHP+) has fallen by over 100,000 participants – an 8% decline.
Nationwide enrollment in Medicaid and the Children’s Health Insurance Plan (CHIP) fell by 2.3%, or 1.7 million, in the same period.
Medicaid provides health coverage to millions of Americans who otherwise could not afford health insurance, including children, pregnant women, elderly adults and adults with disabilities.
CHP+ is a low-cost health insurance program for uninsured children whose families earn too much to qualify for Medicaid but cannot afford private insurance. The programs improve health outcomes, reduce unnecessary costs to the health system and are essential to the health and well-being of roughly 1.2 million Coloradans.
With the drop among Medicaid and CHP+ enrollees, there have been reports from Colorado Children’s Hospital and the state’s safety net clinics that significantly more uninsured patients are coming through their doors.
This is an alarming trend that demands collaborative solutions developed by Coloradans concerned about health care access, legislators, providers and the Colorado Department of Health Care Policy and Financing (HCPF), our state Medicaid agency.
A major factor in the declining numbers has been increased scrutiny of state Medicaid programs by the federal Centers for Medicare and Medicaid Services (CMS). Raising concerns about Medicaid payments made to states for ineligible people, CMS Administrator Seema Verma promised to “take action” by tightening the standards for Medicaid eligibility verification.
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Unfortunately, the administrator’s zeal for improving “program integrity” by increasing bureaucratic red tape is resulting in enrollment declines among people who are eligible for the programs.
The federal crackdown has led to a flurry of federal audits, including one in Colorado that looked at 60 cases, and found Colorado made Medicaid payments on behalf of 14 people who were ineligible and four people who may have been ineligible. Projecting the limited findings on to the whole Colorado Medicaid population, the audit estimated improper payments amounting to $93 million.
The extremely small sample size for a Medicaid population of 1.2 million people raises questions about the audit’s methodology and credibility. It’s also important to note that these audits never look for or quantify errors in the other direction – denials of coverage for people who are eligible.
Federal pressure surrounding these audits has pushed states to place greater emphasis on frequent wage checks, more stringent documentation requirements and terminations based on returned mail.
Research and decades of experience show that increasing paperwork leads to loss of coverage among eligible people. For many families struggling to get by, having to jump through too many hoops to maintain Medicaid coverage is simply too much to manage.
In addition, many enrollment errors found in federal audits reflect challenges inherent in determining Medicaid eligibility. An individual’s eligibility in any given month is based on both monthly household income and household size.
But household size and income are not static since family dynamics, income sources and work hours fluctuate – especially among workers who are paid low wages.
Add to that complex eligibility rules, a clunky eligibility computer system, confusing client notices and an unreliable postal system in many areas and it can be challenging, if not impossible to satisfy reporting responsibilities and determine eligibility at any given point in the year.
As a result of those inherent challenges, the types of errors identified in the audits can likely be reduced but certainly not eliminated.
Even though HCPF is under substantial federal pressure to add barriers to eligibility, it is critical that the department collects data on who loses coverage due to terminations based on returned mail and increased bureaucratic hurdles
It is also essential that Colorado take steps to identify eligible but not enrolled Coloradans and connect them to coverage. State Rep. Susan Lontine plans to run legislation in 2020 that will help uninsured Coloradans enroll in coverage through the regular process of filing their taxes.
While not a full solution, Coloradans will have to work at the legislature, at the administrative level and in partnership with each other to protect Coloradans’ access to care in the context of federal efforts pushing the other way.
Allison Neswood is a Health Attorney for Colorado Center on Law and Policy, a nonprofit research, legislative and legal advocacy organization committed to promoting racial equity and economic security for Coloradans facing poverty. She can be reached via email at aneswood@cclponline.org. Twitter handle: @NesPolicyWatch