As many as 12 states have struggled to comply with federal guidelines for redetermining eligibility of their Medicaid population – enough so that the federal government has had to intervene.

The Centers for Medicare & Medicaid Services has reportedly halted Medicaid eligibility redeterminations in six states since April and worked closely with six more after concluding that they were not complying with its guidelines for how to go about redetermining the eligibility of the nearly 94 million Americans who were on the Medicaid rolls when the COVID-19 public health emergency ended.  During that emergency, many people became newly eligible for Medicaid and states were prohibited from removing them from their rolls in exchange for enhanced federal Medicaid matching funds.

Now, states are undertaking a challenging, labor-intensive process of reviewing the eligibility of the 94 million people, doing so under CMS guidelines, and so far, at least three million people have been disenrolled from Medicaid – three-quarters of them not  because they no longer meet their states’ Medicaid eligibility criteria but for procedural reasons generally involving completing paperwork in a timely manner.

CMS will not identify the states that have had problems with this Medicaid unwinding process.

The process of redetermining Medicaid eligibility fairly and efficiently is especially important to community safety-net hospitals because they serve so many more low-income and Medicaid-insured patients than the typical hospital.

Learn more about Medicaid eligibility redetermination and the challenges states have encountered with this undertaking in the Healthcare Dive article “CMS pausing Medicaid redeterminations in states noncompliant with renewal requirements.”