The Biden administration this week sent letters to state health officials, warning that many are failing to meet federal requirements about determining Medicaid coverage for tens of millions of people in the wake of the pandemic public health emergency.
The Centers for Medicare and Medicaid Services (CMS) has expressed concern for months that many states are rushing through the process, resulting in people losing coverage for "procedural" reasons even though they may still be eligible.
But the agency has so far been reluctant to take formal action against states that violate federal rules.
The CMS on Wednesday made public letters it sent to all 50 states, flagging three key areas of concern: high rates of people losing Medicaid because of paperwork problems, long call center wait times and call abandonment rates, and slow application processing.
The letters were based on data reported by states in May only, so the numbers have changed since then, and not every state is reporting.
While much of the attention has been on the Republican-led states rushing through the process, the letters cited 36 states for at least one problem, including blue states.
Five states — Alaska, Florida, Montana, New Mexico and Rhode Island — were cited for all three issues.
For example, Alaska reported that 28 percent of renewals due in May were terminated for procedural reasons.
"This high percent raises concerns that eligible individuals, including children, may be losing coverage," the agency said. Alaska's call center wait time averaged 16 minutes, with nearly a quarter of all callers hanging up before completing the process.
Florida in May reported 14 percent of beneficiaries terminated for procedural reasons and an average call center wait time of 32 minutes. The average call abandonment rate was 38 percent.
"Excessive call center wait times and call abandonment rates may indicate that the state is not meeting the requirements of providing a meaningful opportunity to complete an application or renewal for Medicaid and CHIP telephonically," the CMS wrote.
At least 4.1 million Medicaid enrollees have lost coverage as of Aug. 9, according to KFF tracking the most current data from 42 states and the District of Columbia. Of those, 75 percent were disenrolled because of procedural reasons.
"While CMS expects procedural terminations, a high rate of procedural terminations may indicate that beneficiaries may not be receiving notices, are unable to understand them, or are unable to submit their renewal through the required modalities," the agency said in the letters.
