Medicaid Monday: The Unwinding Has Begun

Jessica Lynch

Beginning January 28, Texans enrolled in Medicaid started receiving notice from HHSC informing them of the Medicaid unwinding. The end of continuous Medicaid coverage means millions of Texans who have not had to reapply for Medicaid in the last three years will have to go through the process soon. Members who have not signed up for alerts on?YourTexasBenefits.com ?will receive a letter in the mail.?

Why it matters: HHSC estimates 2.7 million individuals received continuous eligibility coverage since the pandemic began. The large number of redeterminations needed, coupled with individuals new to the process, means millions of Texans—mainly children, might get caught in a bureaucratic backlog that could leave families frustrated and without access to care.

Catch up quick: In December, the 2023 federal Consolidated Appropriations Act separated the continuous Medicaid coverage requirement from the COVID-19 Public Health Emergency. The requirement for states to maintain continuous coverage in exchange for enhanced federal funding ends March 31.?

?MCOs are hard at work?assisting their members with eligibility renewals, as part of their existing contracts with HHSC. A new Case Assistance Affiliate program launched during the pandemic provides managed care plans and dental contractors with additional tools to assist their members navigate renewal challenges during the Medicaid Unwinding, including the ability to:

• Virtually assist members to access the YourTexasBenefits eligibility website
• Help recipients navigate the application process
• Reset passwords
• Update contact information

This session, legislators have an opportunity to make the Case Assistance Affiliate program permanent, which can permanently address state workforce challenges, alleviate exceedingly long wait times to reset forgotten passwords that require resetting over the phone, and help Texans who lack access to or are unfamiliar with eligibility verification documents.?

What’s the plan:?HHSC will distribute the continuous coverage population into three cohorts:

• The first cohort includes individuals who are not likely eligible for Medicaid.
• The second cohort consists of members who are likely eligible for other programs.
• The third are those individuals who likely remain eligible for Medicaid.

Each cohort will take about 6 months?and will each be staggered by about one month. To make it easier on families, if anyone in the household is in a cohort everyone in the household will be redetermined at the same time, regardless of initial cohort assignment.

• Families should watch for renewal notices mailed in a yellow envelope that says “Action Required” in red if the member has not signed up for electronic notices. Members have 30 days to respond to renewal packets and requests for information.?

There are protections: States may not disenroll anyone based on returned mail unless the?state has attempted to contact the member through multiple methods. If returned mail is delayed and an individual is disenrolled, HHSC can reenroll the member without having the member reapply if it’s within 120 days. Should HHSC be the cause of any delay, families will maintain coverage until HHSC is finished processing new information.?

?Important dates for enrollees:

• Feb. 18: HHSC determines who belongs in each cohort
• March: HHSC begins checking electronic data sources to determine eligibility for the first cohort
• March 31: Last day of continuous coverage requirement
• April 1: First day disenrollments can become effective
• November: About the time HHSC expects to complete all redeterminations
• March 31, 2024: Last day to initiate renewals and redeterminations in Texas
• May 31, 2024: Last day to complete renewals and redeterminations in Texas

Go deeper: HHSC has an?unwinding website , complete with FAQs.