BY: LORI KERSEY – SEPTEMBER 27, 2023 5:55 AM
The state of West Virginia will restore health coverage to approximately 5,500 children who were wrongly removed from the Medicaid rolls because of an issue with the eligibility system, a spokeswoman for the Department of Health and Human Resources said Tuesday.
West Virginia is one of 30 states that the Centers for Medicaid and Medicare said last week was not complying with federal requirements to do automatic renewals, also called ex parte renewals, at the individual level rather than the household level, as states return to pre-pandemic eligibility rules for the program.
Automatic renewals rely on available financial information for the recipient rather than sending them a renewal form to complete.
Children are eligible for Medicaid and CHIP at higher income levels than adults. By renewing the recipients at a household level, states could be disenrolling children who are still eligible for the programs.
Jessica Holstein, interim director of communications for DHHR, said Tuesday the state currently does ex parte renewals only for its MAGI population, meaning those who qualify for the program based on income. The state has a CMS-approved mitigation plan for the non-MAGI population that does not remove them from the program because of procedural issues like not completing a renewal form.
The state completes redetermination of eligibility for each member of the household, Holstein said. After a “thorough analysis” of the latest interpretation from the federal government on Aug. 30
EditSign, the state identified an issue with the eligibility system that affected 5,500 children in households with at least one adult enrolled in Medicaid that missed at least one month of coverage since disenrollments began in May, she said.
“These children should have been approved through the ex parte process, but were mailed a renewal form that was subsequently not completed,” Holstein said. “[The Bureau for Medical Services] will restore coverage to these children by the end of October 2023.”
States were prohibited from removing people from Medicaid and CHIP in order to receive enhanced funding from the federal government for three years during the pandemic. In that time, West Virginia’s Medicaid enrollment grew 30% — from 504,760 in March 2020 to 656,269 in December 2022, according to DHHR.
After the federal public health emergency ended, states began sending renewal letters to program participants beginning in April as part of a year-long “unwinding” process.
According to the latest data from the state, for the months of April through August, the state removed more than 100,000 people from Medicaid or CHIP.
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