How Many Medicaid Enrollees Moved In 2020 And What Are The Implications For Unwinding the Public Health Emergency?


The Households First Coronavirus Response Act (FFCRA), enacted at the start of the coronavirus pandemic, requires states to offer continuous enrollment to Medicaid enrollees till the tip of the month by which the general public well being emergency (PHE) ends with a view to obtain enhanced federal funding. Throughout this time, states typically can’t disenroll folks from Medicaid, which has prevented protection loss and churn (transferring off after which again on to protection) amongst enrollees throughout pandemic. The PHE is presently in impact via mid-April 2022 and the Biden administration has mentioned it can give states 60 days’ notice earlier than the PHE ends. Since that discover was not issued in February 2022, it’s anticipated the PHE will likely be prolonged once more, though there may be uncertainty over how lengthy the extension will final.

As soon as states resume redeterminations and disenrollments on the finish of the PHE, Medicaid enrollees who moved inside a state through the pandemic however are nonetheless eligible for protection are at elevated threat of being disenrolled if their contact info is old-fashioned. Many state Medicaid packages are heavily reliant on the mail for communicating with enrollees about renewals and redeterminations, together with requests for info and documentation. States can disenroll people who fail to answer these requests. We analyzed federal survey knowledge for 2020 and located:

  • Roughly 1 in 10 Medicaid enrollees (9%) moved in-state in 2020. A a lot smaller share, simply 1%, moved to a special state within the U.S. People that transfer inside the identical state could proceed to be eligible for Medicaid, whereas a transfer out of state would make them not eligible for Medicaid protection of their earlier state. Shares of Medicaid enrollees transferring inside a state has trended downward in recent times, however traits may have modified in 2021, as extra folks turned vaccinated in opposition to COVID-19 and the national eviction moratorium was lifted in August 2021.
  • Amongst these coated by Medicaid, younger adults and single-parent households with youngsters had been extra prone to transfer inside a state than different teams. Amongst Medicaid enrollees that moved inside the identical state in 2020, half (50%) moved for housing-related causes and 28% moved for family-related causes.

States can take a variety of actions to replace enrollees’ addresses and different contact info to reduce protection gaps and losses for eligible people after the tip of the PHE, notably for people who could have moved inside a state. These actions embody conducting direct outreach to enrollees, partnering with managed care organizations and different stakeholders in outreach efforts, creating clear insurance policies for returned mail, and checking obtainable knowledge sources for extra up-to-date contact info. A recent survey of states discovered that the majority states (46) had been taking proactive steps akin to these to replace contact info, though fewer (35) are following up on returned mail. Cautious monitoring and oversight of state progress through the unwinding interval may present info to stop faulty terminations of protection.

Introduction

To grasp who could also be at elevated threat of shedding Medicaid protection due to out-of-date contact info, this temporary analyzes knowledge from the Present Inhabitants Survey’s (CPS) Annual Social and Financial Complement (ASEC) from March 2021 to look at the share of Medicaid enrollees who moved inside a state (and subsequently usually tend to stay eligible for Medicaid in the identical state) in 2020 and the demographic traits of these people. It additionally examines traits in residential mobility over time and discusses methods states can undertake to reduce protection losses amongst these people.

The information utilized in our evaluation replicate mobility patterns throughout 2020 and had been collected earlier than necessary occasions, akin to when the COVID-19 vaccine turned extensively obtainable to all adults and the tip of the national eviction moratorium, that will have affected the quantity of people that moved extra just lately. Moreover, our evaluation focuses on non-elderly Medicaid enrollees (as a result of enrollees ages 65 and older possible have Medicare as their main supply of protection) and so we confer with non-elderly Medicaid enrollees merely as “enrollees” for the rest of this temporary. See the Strategies field on the finish of this temporary for extra particulars in regards to the evaluation and limitations.

What can we find out about Medicaid enrollees who moved in-state in 2020?

Roughly 1 in 10 Medicaid enrollees (9%) moved in-state in 2020. A a lot smaller share, simply 1%, moved to a special state within the U.S., which might make them not eligible for Medicaid protection of their earlier state. The share of enrollees transferring inside the identical state was barely greater in comparison with people who find themselves not enrolled in Medicaid (8%), though the share was not considerably totally different for non-enrollees who moved to a special state in 2020 (2%). These estimates are primarily based on CPS ASEC knowledge, which asks survey respondents whether or not they lived in the identical home one yr in the past. One limitation of this strategy is that the CPS ASEC knowledge don’t establish individuals who have moved a number of instances over the course of the yr, reflecting extra extreme housing instability that’s extra widespread amongst low-income populations. Moreover, these knowledge don’t establish short-term (or seasonal) strikes through the yr, akin to transferring in with household or pals, which turned more common in 2020 and early 2021 in response to the pandemic.

Amongst these coated by Medicaid, younger adults and single-parent households with youngsters had been extra prone to transfer inside a state than different teams (Determine 1). In 2020, roughly 11% of younger adults (ages 19-34) with Medicaid protection moved in-state in comparison with 8% of youngsters and seven% of adults ages 35-64 with Medicaid. Among the many totally different household sorts analyzed, enrollees who reside in single-parent households had been the most certainly to maneuver in 2020 (12%), whereas enrollees dwelling in multi-generational households had been among the many least prone to transfer (6%). After we in contrast residential mobility by race/ethnicity, a smaller share of Hispanic folks enrolled in Medicaid moved inside state in 2020 (7%) in comparison with White folks (9%), whereas the shares of Black folks (9%) and folks of different races (9%) who moved weren’t totally different in comparison with White folks.

Amongst enrollees that moved inside the identical state in 2020, half (50%) moved for housing-related causes and 28% moved for family-related causes (Determine 2). Housing-related causes embody wanting a greater residence and/or neighborhood, wanting cheaper housing, foreclosures or eviction, and different unspecified housing-related causes. Household-related causes embody establishing one’s personal family, adjustments in marital standing, and different unspecified household causes. Usually, Medicaid enrollees had been extra prone to transfer in-state for family-related causes in comparison with individuals who weren’t enrolled in Medicaid (28% vs. 24%) and had been much less prone to transfer in-state for job-related causes in comparison with individuals who weren’t enrolled (9% vs. 12%). Medicaid enrollees and non-enrollees each moved inside the identical state for housing-related or different causes at about the identical charge. When in comparison with the rationale folks moved in 2018 (the newest measurement yr earlier than the pandemic), Medicaid enrollees’ causes for transferring have stayed comparatively regular regardless of financial disruptions in 2020 associated to the pandemic.

The share of Medicaid enrollees transferring inside the identical state has declined barely in recent times, from 15% in 2014 to 9% in 2020, though that pattern may change in 2021 and 2022 (Determine 3). Declining shares of Medicaid enrollees transferring inside the identical state since 2014 mirrors national trends of fewer folks transferring over time. Nevertheless, the share of Medicaid enrollees transferring has decreased sooner in comparison with non-enrollees in recent times. Whereas the pandemic has raised considerations about financial disruptions and housing instability amongst low-income populations, the information for 2020 point out that residential mobility amongst each Medicaid enrollees and non-enrollees largely adopted pre-pandemic traits. Nevertheless, these traits may have modified in 2021, as extra folks turned vaccinated in opposition to COVID-19 and the national eviction moratorium was lifted in August 2021.

How can states decrease protection losses amongst eligible enrollees who transfer?

With the continual enrollment requirement in place through the PHE and the prohibition on disenrolling people from Medicaid, states might not be speaking commonly with enrollees and, in consequence, could have outdated contact info for many who have moved inside the state through the previous two years. When the PHE ends and states resume routine redeterminations and disenrollments, some enrollees could also be prone to shedding protection just because they don’t obtain notices or renewal info. As states put together to renew regular operations, they’ll take a variety of actions to replace enrollee addresses and different contact info to reduce protection gaps and losses for eligible people. The Facilities for Medicare and Medicaid Providers (CMS) has developed a broad set of policy and operational strategies states can undertake to take care of steady protection for eligible people, together with particular methods for updating contact info and decreasing returned mail:

Conduct communication campaigns via mail, textual content, and e-mail to encourage enrollees to offer up to date contact info. States can ship periodic notices through the PHE to remind enrollees to replace their contact info. To the extent states have various contact info, they’ll additionally attain out via automated cellphone calls, textual content messages and emails. And, to make sure that enrollees are reminded once they proactively attain out to the Medicaid or different social companies businesses, states can replace name middle scripts to request up to date contact info at the start of the decision and might add alerts to Medicaid, CHIP, and social companies web sites.

Companion with managed care organizations (MCOs), community-based organizations, software assisters, and suppliers in outreach efforts. To increase the attain of outreach efforts, states can work with MCOs, neighborhood companions, and suppliers to bolster messages and remind enrollees to offer up to date info. Enrollees are used to receiving communication from MCOs and could also be extra possible to answer reminders from them. Navigators and licensed software assisters will also be efficient companions as a result of they commonly replace contact info throughout interactions with purchasers. States can choose to just accept up to date info from these entities, or within the case of MCOs require that they share this info however ought to develop insurance policies for verifying up to date info with enrollees.

Develop clear insurance policies for following up on returned mail that may embody checking obtainable knowledge sources and contacting enrollees through cellphone, textual content, or e-mail. When mail is returned and no forwarding handle is offered, states are inspired to test obtainable knowledge sources, together with the USA Postal Service (USPS) Nationwide Change of Handle Database, the Supplemental Diet Help Program (SNAP), Short-term Help for Needy Households (TANF) or different packages, and/or contact info from MCOs. They’ll additionally contact enrollees through cellphone, textual content, or e-mail to acquire up to date mailing addresses.

To arrange for the tip of the PHE and steady enrollment requirement, most states (46) are taking proactive steps to replace enrollee addresses, though fewer (35) are following up on returned mail as of January 2022. Actions to replace addresses embody conducting outreach to enrollees, checking different packages for up to date addresses, and dealing with managed care plans and suppliers to replace handle info. States that comply with up on returned mail are most certainly to name or e-mail enrollees utilizing info on file once they acquired returned mail from a discover despatched to an enrollee.

Trying Forward

As states resume redeterminations and disenrollments on the finish of the PHE, proof means that it’s unlikely that enormous proportions of enrollees can be not eligible for Medicaid as a result of they moved out of state. When requested to foretell the first causes folks will lose protection after the continual enrollment requirement is lifted, few states (3) recognized transferring as a key driver of disenrollments, and all cited different causes, together with elevated revenue or different adjustments in circumstances, along with transferring. Whereas the variety of Medicaid enrollees transferring inside the identical state didn’t improve through the first yr of the pandemic, the 9% of Medicaid who moved in-state in 2020 nonetheless quantities to a major variety of enrollees whose contact info is extra prone to be old-fashioned and who’re at elevated threat of shedding protection as states unwind the continual enrollment requirement. Additionally it is potential that, because the pandemic continued into 2021 and 2022, the cumulative variety of Medicaid enrollees who moved has elevated as effectively. States with comparatively giant numbers of disenrollments on account of returned mail could point out faulty terminations, as returned mail alone doesn’t essentially point out a change in financial circumstances that impacts eligibility, particularly when comparatively few enrollees transfer out of state (roughly 1% of enrollees in 2020). Cautious monitoring and oversight of state progress through the unwinding interval may present info to stop faulty terminations of protection.

We analyzed knowledge from Present Inhabitants Survey’s (CPS) Annual Social and Financial Complement (ASEC) from March 2021, 2019, 2017, and 2015. These knowledge present info on who moved through the earlier yr (2020, 2018, 2016, and 2014, respectively). Our evaluation focuses on individuals who had Medicaid protection sooner or later through the yr and who moved inside the identical state (transferring out of state would imply that the enrollee not qualifies for Medicaid protection within the earlier state). We exclude enrollees ages 65 and older since almost all would qualify for Medicare and are much less prone to lose their main supply of protection. Youngsters below age 1 are additionally excluded as a result of the CPS ASEC questions on transferring as of March of the earlier yr will not be relevant to respondents below age 1. Our evaluation additionally focuses on people who moved inside the US. Whereas our evaluation features a small quantity of people that have moved from exterior the U.S. (i.e., from a US territory or a overseas nation), we don’t embody these people in our counts of people that moved in-state or to a special state. For the March 2021 CPS knowledge (and never for earlier years), we analyzed variations in chosen demographic teams, together with age group, household sort, and race/ethnicity. We additionally analyzed the share of individuals transferring inside state by intercourse, city/rural (utilizing metropolitan statistical areas as a proxy), and overseas born, however we didn’t discover important variations between these teams and so will not be proven in Determine 2. All variations reported on this temporary are measures on the p < 0.05 degree.

The evaluation focuses on people and makes use of particular person weights, which is necessary for decoding our findings on demographic teams. For instance, though youngsters will sometimes transfer with adults, the distinction between little one enrollees and older enrollees displays conditions the place adults don’t reside with youngsters or, in some instances, youngsters (particularly these aged 18) who don’t reside with adults. In different households, the kids could also be enrolled in Medicaid however their dad and mom will not be, or there might be extra youngsters enrolled in Medicaid than adults (or vice versa). In analyzing household sort, we contemplate the kind of household for every particular person. For instance, whereas we excluded enrollees ages 65 and older from our evaluation, little one enrollees who reside with their dad and mom and grandparents are thought of to reside in multi-generational households.

We performed a robustness test of our findings by evaluating the share of individuals transferring in-state as recognized within the CPS ASEC versus the American Neighborhood Survey (ACS). We in contrast findings for Medicaid enrollees and non-enrollees ages 1-64, utilizing knowledge collected within the March 2019 CPS ASEC pattern and the 2019 ACS pattern. Usually, the p.c of individuals transferring in-state over the previous yr had been barely decrease within the March 2019 CPS ASEC pattern (11% of enrollees and eight% of non-enrollees) in comparison with the 2019 ACS pattern (13% of non-enrollees and 11% of non-enrollees). We might count on some variations on account of different and data collection methods and timing between CPS and ACS, and so the distinction of two or 3 share factors appeared moderately small.

Our findings have necessary limitations. First, the CPS ASEC pattern doesn’t inform us when an individual moved. So, we have no idea whether or not the particular person was enrolled in Medicaid earlier than, throughout, or after the transfer. Moreover, we have no idea what number of instances an individual moved and, relying upon timing, short-term strikes might not be captured. Second, the most recent CPS knowledge used right here solely present knowledge for 2020, however the financial impacts of the pandemic have lasted for much longer, together with when the federal authorities lifted the national eviction moratorium in August 2021.

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