Tech ‘Glitch’ Is Causing Kids to Lose Medicaid Coverage

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A Medicaid “glitch” is removing health care coverage for potentially millions of children, U.S. health officials warned Wednesday.

Automated systems involved in a large-scale eligibility review are causing entire households to be removed from Medicaid coverage, according to a news release from the U.S. Centers for Medicare & Medicaid Services (CMS), but children in the home may still be eligible based on family income even if their parents are not.

“I think it’s a very significant problem,” Joan Alker, executive director of Georgetown University Center for Children and Families, told the Associated Press. The center is tracking the Medicaid renewal process in each state.

The eligibility review is happening now because a prohibition on removing people from Medicaid that was established during the pandemic ended this spring.

During that time, Medicaid rolls of those provided coverage grew from 71 million to 94 million, the AP reported. Now, states are returning to annual eligibility determinations.

The process of determining eligibility can include using computer programs to review income and household information, including whether someone received unemployment benefits or food assistance, and sending notices asking people to verify their eligibility.

Those who don’t qualify or don’t respond can be dropped by Medicaid.

But most states allow children to have coverage at much higher household income levels than for adults, the AP reported.

In many states, “eligible kids are not being successfully renewed, and that is a violation of federal requirements,” Daniel Tsai, director of the CMS Center for Medicaid and Children’s Health Insurance Program Services, told the AP.

About 5 million people have lost coverage during these eligibility reviews, the AP reported.

Maryland is among the states inadvertently purging kids from Medicaid rolls.

“Maryland has responded immediately and is working closely with CMS to resolve this issue in a way that helps keep eligible individuals, particularly children, covered on Medicaid,” Ryan Moran, the state’s Medicaid director and deputy secretary of health care financing, told the AP.

To resolve it, the state is pausing all “procedural terminations,” which are those in which someone is removed for not responding to a letter. It is also retroactively reinstating coverage for children who weren’t renewed automatically, the AP reported.

The state has found more than 3,100 children were potentially affected, though some may still be ineligible, the AP reported.

In Missouri, staff are working manually to renew coverage for those children who are eligible when their parents are not, which is extending the time it takes to complete the eligibility review, said Caitlin Whaley, a spokesperson for the state’s Department of Social Services.

The CMS is giving states until Sept. 13 to report whether this glitch is happening in their states. They are being told to pause procedural terminations, reinstate coverage for those inadvertently dropped and find a solution to prevent this until the automated system is fixed, according to the CMS.

More information

The American Academy of Pediatrics has more on poverty and children’s health.

SOURCES: U.S. Centers for Medicare and Medicaid Services, news release, Aug. 30, 2023; Associated Press

Source: HealthDay

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