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Although hundreds of thousands have been knocked off state Medicaid rolls this spring, worries about dropped coverage for Medicaid-dependent nursing home residents have so far not proven reality in large numbers.

McKnight’s Long-Term Care News surveyed a dozen sector associations about the impact the end of the COVID-19 public health emergency and a Medicaid continuous coverage requirement have had on facilities. Several were unable to provide detailed insight, noting that they had not heard from members that they were experiencing widespread disenrollment issues. 

“At this time, LeadingAge PA members are not reporting any significant impact due to the PHE Medicaid unwinding and are following the standard processes they have in place to ensure the needs of their Medicaid-eligible residents continue to be met,” Katie Andreano, a spokeswoman for the association told McKnight’s on Friday. 

Andreano’s comment was representative of those from several other associations. 

A report from KFF last week found that more than 600,000 beneficiaries have lost coverage in 14 states since the end of April. Leading the pack is Oklahoma, where some 70% of disenrollments have been due to procedural issues, rather than proven ineligibility. 

Neither the Oklahoma Health Care Association nor Oklahoma LeadingAge were able to provide comment to McKnight’s on the situation in nursing homes in the state. 

KFF’s reporting did not break out the numbers of Medicaid recipients using their benefits for long-term care facilities compared to other approved uses. But KFF noted that “the overwhelming majority” who lost coverage were dropped due to technicalities such as not returning paperwork or omitting required documents and not because of ineligibility with Medicaid’s income limits.

Understanding the unwinding

The KFF article noted that 53,000 residents in Indiana lost coverage soon after the state began the unwinding process.

Deeksha Kapoor, a spokeswoman for the Indiana Health Care Association, told McKnight’s that the state’s Family and Social Services Administration’s Office of Medicaid Policy and Planning developed a communications plan ahead of the April 1 start of the redetermination period. The approach included webinars, handouts and outreach materials to help facilities understand the requirements so that Medicaid recipients did not experience a disruption in their benefits. She said the association has not heard from any members that residents have lost coverage. 

But the possibility raised concern among nursing home providers, with some in New Jersey telling McKnight’s last month that they worried staff shortages at the state agency handling reenrollments could create delays in processing required patient paperwork.

Health Care Association of New Jersey CEO Andy Aronson said such concerns, while still being voiced by members, had not become reality.

In Pennsylvania, where KFF’s data shows 14% of beneficiaries lost coverage for procedural reasons and another 18% over ineligibility, providers are experiencing more problems from county assistance offices where approvals can take upwards of a year, Eric Heisler, a spokesman for that state’s health care association told McKnight’s

“This unhurried practice harms providers who continue to care for these residents, because the providers aren’t receiving any reimbursement, which is already insufficient, or the cost of care during that time,” Heisler said, adding that providers will receive a lump sum once eligibility is approved. 

Disenrollment workload

Despite the lack of specificity on the data from KFF about who has lost coverage, Heisler said the overall analysis and concern about disenrollment highlights the significant number of people reliant on government services. More than 70% of all nursing home care in Pennsylvania is paid for by Medicaid, he said. 

“The work nursing home providers are doing around supporting residents in continuing their eligibility is one more task added to their list of things to do to ensure care for their residents, but it isn’t new,” Heisler said. “Long-term care is an industry that has regulated a normalcy of prioritizing paperwork over patients.”

In Arkansas, a spokesman for the Department of Human Services told McKnight’s that they have been working with long-term care facilities and others to prepare for this move. Spokesman Gavin Lesnick said in an email that the department has brought on contractors to help with the increased caseload associated with unwinding eligibility. 

Arkansas’ continuous coverage requirement expired on April 1. On May 8, it announced that 54,300 individuals had been disenrolled from Medicaid after the state began redeterminations after a three-year hiatus. Many of those who were disenrolled could not be located, did not return renewal forms on time, or did not answer requests for more information.

KFF’s analysis found that 45% of Medicaid recipients in Arkansas lost coverage due to procedural reasons while just 6% were dropped for confirmed ineligibility for either Medicaid or the Children’s Health Insurance Program.