As  a new study by KFF (formerly spelled out as the Kaiser Family Foundation) explains, “Congress is debating cuts to Medicaid of up to $880 billion or more over ten years, citing a desire to curtail spending to help pay for tax cuts and address ‘fraud, waste, and abuse’. While several proposals would fundamentally restructure who is covered by the program and how it is financed, repeal of regulations finalized in the last administration, including the Eligibility & Enrollment (E&E) rule finalized in April 2024, are also under consideration.”

How can states prepare themselves for a massively uncertain future now? 

Here are some of KFF’s findings based on its 23rd annual survey of state Medicaid and CHIP program officials which it conducts in collaboration with the Georgetown University Center for Children and Families:

• “Most states are continuing to implement policies to increase ex parte, or administrative, renewal rates.” From the depths of the pandemic through March 2023, states received stipends from the federal government, which allowed them to cease cutting down their Medicaid rolls. Since then, during the so-called unwinding period, “states employed new approaches to using data and automation to streamline processes for verifying eligibility,” according to KFF. 

• “States increasingly rely on data from trusted sources to automate manual tasks and improve accuracy of Medicaid eligibility, enrollment, and renewal processes. By advancing the use of information from other programs such as SNAP and TANF, states have improved the accuracy of income verification while reducing administrative burden associated with mailing renewal forms and manually processing information submitted by mail or phone.”

• “States have incorporated new strategies for updating contact information and communicating with enrollees into routine operations, and some are using artificial intelligence (AI) to assist with the application and renewal processes. Access to the US Postal Service National Change of Address (NCOA) Database and other program data allows states to routinely update mailing addresses, tackling the longstanding problem of returned mail. Nearly all states proactively check available data sources for updated contact information or accept updated addresses from managed care plans or providers. To increase renewal response rates, states contact enrollees multiple times before and after sending renewal notices using multiple modes including email and text. States have also enhanced online tools –online accounts and mobile apps – to provide additional ways to communicate with enrollees and to give enrollees the ability to more easily manage their coverage.”

• “States have taken steps to remove administrative barriers to enrollment and renewal for children and seniors and people with disabilities (non-MAGI groups). Almost all states with separate CHIP programs have eliminated required periods of uninsurance (waiting periods) and lock-out periods following nonpayment of premiums, both of which contribute to gaps in coverage.” (Non-MAGI groups refer to those whose eligibility is not determined based on Modified Adjusted Gross Income). 

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