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A volunteer takes personal information from a woman about to receive a coronavirus vaccine during an event at the Lincoln County Fairgrounds on March 19, 2021. (Brian Malone, Special to The Colorado Sun)

In normal times, about 35,000 people drop off the government health insurance plan for the needy each month, usually because someone in their household got a new job and they no longer qualify.

But since the coronavirus pandemic, and a federal public health emergency declaration more than two years ago, no one has lost their Medicaid benefits. 

Colorado has added nearly 500,000 people to its Medicaid rolls since early 2020, an increase of 32%. 

The latest extension of the federal order — which says that states can cut no one off the Medicaid rolls during the global crisis, whether they are eligible or not — is set to expire Oct. 13. Another 90-day extension is likely, considering there’s an election in November and coronavirus numbers have typically surged in the fall, but states are gearing up now to avoid surprise losses of health insurance for hundreds of thousands of people. 

There are no gotchas in here. These are people’s lives and their health care.

Ralph Choate, Colorado Department of Health Care Policy and Financing

“None of this is supposed to be a surprise,” said Ralph Choate, chief operating officer for the Colorado Department of Health Care Policy and Financing, which includes the Medicaid division. “There are no gotchas in here. These are people’s lives and their health care.”

The department, in its annual stakeholder meeting Tuesday, outlined a plan to make sure anyone who is still eligible for Medicaid doesn’t get kicked off the program when the public health emergency expires. And state officials estimate there are 455,593 people enrolled in Medicaid who likely would not meet eligibility requirements today, though many of them will likely qualify for some other form of benefits such as the state’s child health plan

The crux of the plan is a communication blast — planned for late summer and fall — asking the 1.65 million people on Medicaid in Colorado to make sure the program has their current contact information. 

“I hope we go through this whole thing and never have somebody that goes, ‘Wait, wait, but I should have responded,’” Choate said. “I’m so hoping we don’t have that.”

Everyone on Medicaid is required to fill out paperwork each year before their coverage anniversary date, information used to determine whether they are eligible for another year. Colorado has been asking people to file the income and health information throughout the pandemic, even though no one will lose coverage. 

People who didn’t have a job in 2020 and qualified for Medicaid, but now have a job and no longer qualify, receive notice after the annual review that they are only receiving benefits because of the public health emergency. So, state officials say, no one should be caught off guard. The problem is, about 25%-30% of people neglected to participate in their annual revalidation process, either because they never got around to it or perhaps because they feared they could lose coverage once they reported a change in income.

The federal government has promised a 60-day notice of when the public health emergency will expire.

Once it does, Colorado Medicaid officials face a 14-month process of notifying every participant 60 days ahead of their re-enrollment date that this time, they must show they are eligible or potentially lose coverage. 

The logo for the Colorado Department of Health Care Policy and Financing, which administers Medicaid in the state, on a sign in the department’s offices on Feb. 26, 2019. (John Ingold, The Colorado Sun)

While the department is estimating that more than 455,000 might no longer be eligible, an exact number is difficult to determine. Part of the reason is because of Colorado’s high number of seasonal workers, especially those in the skiing, rafting and tourism industry.  

“There are a lot of folks here in Colorado, they have a job, don’t have a job, have a job, don’t have a job,” Choate said. “They’ve been going back and forth, in some cases for years,” on Medicaid eligibility. 

The goal is to keep people on Medicaid if they qualify, and to offer reduced benefits to others if they fit the criteria. For example, Colorado recently passed a law that says people are eligible for Medicaid for a full year following a pregnancy, instead of the prior timeline of three months. Those who do not qualify for any benefits will get linked to Connect for Health Colorado, where they can purchase health insurance through the state marketplace. 

The annual income limit for a family of four to qualify for Medicaid is about $35,000, while the income limit is $69,000 to qualify for the state’s child health plan.

Colorado is in better shape than some states that did not go through the annual revalidation process during the pandemic, state officials said. 

The Colorado Department of Health Care Policy and Financing’s government-funded insurance programs, including Medicaid, Child Health Plan Plus and an indigent-care program, cover about one in four state residents. 

The $14.2 billion program also boasts that it has increased the number of medical and mental health providers who accept Medicaid clients, now totaling 95,000. Among those, more than 10,000 are mental health and substance abuse counselors, about 1,100 of which began accepting Medicaid in the last year, according to the department. 

Two-thirds of all telehealth appointments covered by Medicaid are behavioral health appointments, officials said. 

Medicaid officials said they now have new systems in place to manage enrollment policies during public health emergencies.

“I think we have to operate under the assumption that there is going to be a next time,” Choate said.