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SALT LAKE CITY — An advisory committee made of Medicaid beneficiaries, community organizations and health care providers has expressed concerns about how the state is executing its "unwinding plan" as COVID-19 Medicaid policies are withdrawn.
Utah is now a few months into its Medicaid unenrollment or "unwinding" period, as benefits that were easier to obtain and retain during the COVID-19 pandemic are now being reevaluated under the usual guidelines.
The advisory committee said in a letter that the large number of procedural closures indicates Utahns are losing their coverage unnecessarily and are still eligible. It said national data shows Utah's rate of procedural closures is twice the national average.
Michael Hales, chairman of the advisory committee, said in a committee meeting last week it sent the letter on Aug. 30 that led to a conversation between the committee and Tracy Gruber, executive director of the Utah Department of Health and Human Services. He said they talked about the experience people are having with the unenrollment process and how the department can help raise awareness and make calling the Medicaid office more user-friendly.
"Overall, I think very positive discussion," he said.
He said the committee is being heard and taken seriously.
The letter said 97% of the Medicaid unenrollments in Utah were procedural, while 1.8% were due to a review that determined the person was ineligible. And almost one-third of the closed cases were reinstated.
It also said wait times and the number of people abandoning calls to Medicaid show that people are trying to complete their reviews but are not able to get help. The letter said the average call wait time is 36 minutes and about 25% of calls — around 30,000 — were abandoned.
"This performance is among the worst in the nation and presents extreme challenges to those with technological and connectivity barriers. The call wait times and abandonment rates almost certainly led to members losing coverage inappropriately," the letter said.
It also said that Centers for Medicare & Medicaid Services gave states more flexibility during the unwinding process than Utah has been taking advantage of, and the committee encouraged the health department to adopt additional flexibility procedures suggested federally. These flexibilities are associated with increasing ex-parte reviews, supporting enrollees with their forms, and facilitating reinstatement of people who were unenrolled but should qualify for benefits.
"This performance is among the worst in the naton and presents extreme challenges to those with technological and connectivity barriers. The call wait times and abandonment rates almost certainly led to members losing coverage inappropriately," the letter said.
In August, there were 33,000 accounts closed — 16,444 of which were procedural and due to missing paperwork or incomplete reviews.
A graph shown during the meeting said of those 33,000 accounts, about 25% were pregnant women and about 11% were elderly.
Lisa Heaton, who is on the committee, clarified that some of the thousands of cases that closed were for people who got enrolled during COVID-19 when they did not have to take regular steps to stay on Medicaid, and now that they do they are not aware of those steps.
She also said some of thousands of accounts closed were ones where people are already enrolled in a program that was more applicable to their current situation, so they just represent people who have learned the new process — not people who have lost benefits.
Stephanie Burdick, a member of the advisory committee, said there have definitely been some erroneous closures. She talked about a 28-year-old she knows who died because his Medicaid account was closed and he was not able to get treatment for a treatable disease. She said his phone died while he was trying to get to the hospital, and a friend pushed him 15,000 steps to the hospital but he still did not get the care he needed to survive.
She said the Department of Health needs "to go the extra mile" because when people don't have health insurance coverage they have health problems that they will not be able to address. She encouraged the representatives from the department to act more quickly on their plans already presented to the committee and said Medicaid is a legal right for people who are eligible to stay enrolled.
"We all knew that the unwinding was going to happen," she said.
She reiterated that not having access to Medicaid causes actual harm, and the problems they are seeing are not surprising — they were discussed a year ago.
"It matters for people to be able to take their kids to the doctor. … Losing coverage just breaks my heart," Burdick said.
Jennifer Strohecker, Utah Medicaid director, said the Utah Department of Health and Human Services is committed to helping members who are experiencing problems with the Medicaid enrollment and unenrollment process.
She said they recognize that they do not have educational information about unenrollment that was planned in place when the process started, but that she is committed to improvement.
"The person is very central to our work," she said.
