Between unwinding and renewals, SD health providers seek to bridge larger-than-expected Medicaid gap

May 31—MITCHELL — Sixteen thousand South Dakotans have lost their Medicaid coverage, as pandemic-era pauses on disenrollments have ended.

By the time the flood of backlogged eligibility checks finishes, an estimated 22,000 South Dakotans could be disenrolled from coverage, according to estimates by the state Department of Social Services (DSS).

But previous expectations — that many losing coverage could regain it through this summer's Medicaid expansion — look to be thwarted.

A more recent DSS report reviewing the April 1 unwinding estimated that only 1,700 will ultimately be eligible for renewed coverage under the expansion, just above one-tenth of those who have already been removed from the program.

"It's a new process and it hasn't ever happened on this scale," said Kristin Longville, the patient support services coordinator with Horizon Health Care, a South Dakota-based health care provider offering assistance for those seeking coverage.

The restart of reviews marks a return to normal oversight of Medicaid, a federal program that helps a range of people, including children, pregnant women, elderly adults, people with disabilities and

low-income groups

pay for their health care coverage.

For three years, the federal government had prevented anyone from being dropped from Medicaid coverage, halting usual coverage reviews due to the pandemic. During normal years of operation, Medicaid is renewed on a periodic basis in order to determine who is and who is not eligible for that coverage. In South Dakota, monthly reviews are conducted in addition to federally required annual ones.

Reviews are conducted using state databases that contain data relevant to eligibility. One main criterion of eligibility is income: in South Dakota, the qualification thresholds range from 46 percent of the poverty line for parents and elders 19-65, all the way up to 182 percent for the caretakers of children 0-6.

The current federal poverty line is $14,850 for an individual and $30,000 for a family of four.

If an individual is flagged as no longer being within the guidelines for coverage — due to changes such as an increase in income or change in residence — they will be removed from Medicaid unless they can "resolve the discrepancy within the specified time-frame (often limited to within 10 days from the date of the notice)," according to

the Kaiser Family Foundation

.

However, the review process had been stopped due to a March 2020 federal policy known as the Families First Coronavirus Response Act, which required states to suspend Medicaid eligibility reviews, among other criteria, if they wanted to receive program funding. The pause lasted for about three years, ending on March 11, alongside the public health emergency designation. On April 1, South Dakota became one of the first five states nationwide to resume eligibility reviews of Medicaid recipients.

In addition to a return to normal operation, the restart on reviews comes just months before a July 1 expansion of Medicaid coverage is set to increase coverage for adults 19-65, after South Dakota voters approved a constitutional amendment on the 2022 general election ballot.

Notably though, previous predictions — estimating that the summer's expansion would greatly offset the coverage decreases from the restart of reviews — no longer seem to be the case.

In April, state Deputy Director of Medical Services Sarah Aker told the South Dakota Board of Social Services that around half of the expected disenrolled

would regain coverage when the Medicaid expansion law would pass into action this summer

, according to news coverage by South Dakota Searchlight.

Now, with the gap in Medicaid coverage larger than expected, health care providers are working hard to tackle the challenges of the large-scale disenrollments.

Longville said that there are a couple main issues that Horizon Health is trying to tackle. First, people may not be aware of the resumption of Medicaid reviews. Second, many are otherwise unclear on how it will affect them.

To combat this, Horizon Health Care sent out 1,100 letters to Horizon patients earmarked by the Medicaid office, notifying them of the resumption of reviews and offering them support services to find renewed coverage. They have also provided in-person services to meet the needs of patients who are lacking in information about the unwind, and what their next steps to find health care coverage will be.

"In some cases, people might not know until they go to their next doctor's appointment or to get their next medication refill. That's what we're trying to prevent," Longville said. "Health insurance is complicated. It's expensive. Quite a few people have questions — what's changing and what are my next steps? What does this mean and where do I go from here?"