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State Dashboards to Monitor the Unwinding of the Medicaid Continuous Coverage Requirement (Cross-Post)January 11, 2024:
The following content is cross-posted from State Health & Value Strategies.
Authors: Elizabeth Lukanen, Emily Zylla, and Lindsey Theis, SHADAC
This expert perspective (EP) will be updated by SHADAC experts as additional dashboards/reports go live. Please visit the State Health & Values Strategies webpage for the most recent version of this EP.
Original publication date: March 16, 2023. Updated January 11, 2024
As the unwinding of the Medicaid continuous coverage requirement continues, both states and the federal government are tracking and monitoring the impacts of the resumption of eligibility redeterminations and disenrollments. The Centers for Medicare & Medicaid Services (CMS) continues to release monthly batches of required state data reporting metrics. However, given the time-lags and caveats of the CMS data, many states have decided to also publish their own state data dashboards. On December 18, 2023 CMS released an informational bulletin that, for the first time, officially encouraged states to supplement their federal reporting with their own state-specific data analysis, as well as to follow best practices of reporting data broken down by eligibility group and other demographic characteristics (e.g., age, race, ethnicity, language).
Releasing state-data via a dashboard or some other format allows states to follow other specific best practices, including the ability to provide additional detail about definitions, timeframes, and state context that are important for communicating the unique and specific circumstances that states are experiencing during unwinding. Colorado’s state dashboard, for example, highlights the state’s lower unemployment rate and provides context around the state’s reconsideration period in order to help users understand the CMS data reports. Several states are also using state data and insurance dashboards to report how many individuals have been reinstated in Medicaid after a termination (see the SHVS expert perspective on States’ Reporting of Medicaid Unwinding Reinstatement Data), thus telling a more complete story about what happens to individuals after they are disenrolled.
States Publicly Posting Unwinding Data
To date, 47 states including the District of Columbia (D.C.) have publicly published their own unwinding data in some format (this does not include states with pre-existing enrollment dashboards that don’t specifically identify unwinding cohorts). In most cases, state Medicaid departments are releasing those data, although some State-Based Marketplaces (SBMs) are also publishing unwinding data (see the SHVS expert perspective on SBM Marketplace Transition Data During the Unwinding). Of the 47 states currently reporting data:
- 24 release state unwinding data online in either an interactive dashboard or static pdf format.
- Three states only release copies of their required CMS Monthly Unwinding Data
- 20 states release both state data and their CMS Monthly Unwinding Data reports.
In some cases, states are publishing unwinding information in an ad-hoc way—such as by a press release. Because these data are not being systematically reported, they are not represented in the map above.
As unwinding has progressed, the number of new states reporting unwinding data has slowed significantly and states are updating their data less frequently. Fifteen states have not updated their state unwinding data reports since October. Arkansas and Idaho report to have completed all redeterminations and are no longer reporting through their unwinding dashboards. Iowa, which was one of the first states to publish a state unwinding dashboard, has removed renewal data from its “Medicaid and Covid Unwind Dashboard.” Both Arkansas and Iowa, however, do continue to make monthly reports to CMS publicly available.
The public release of unwinding data has proven to be a valuable tool in understanding who is losing Medicaid coverage and why. States and advocates have successfully used the data to both monitor outcomes and adjust strategies. While CMS previously indicated it would continue reporting unwinding data through June 2024, CMS’ December informational bulletin noted that states that are not meeting unwinding deadlines or experiencing other compliance issues may be required to provide additional data and/or report information more frequently. Therefore, we encourage all states to continue to make detailed disenrollment, renewal, and call center data (in addition to the enrollment data most states already report) available publicly on an ongoing basis.
SHADAC will continue to update this expert perspective as states update their unwinding data.
Variation in States’ Reporting of Indicators
There is a wide variation in the indicators that states are reporting on their state data dashboards and reports. Of the 47 states reporting publicly, most are now reporting renewal and termination data. Some states are also reporting other interesting indicators such as:
- Reasons for procedural denials (see Colorado example below).
- Number of cases terminated that are re-enrolled or reinstated in Medicaid (see Massachusetts example below).
- Qualitative data from individuals about reasons why they did not renew Medicaid (see New Hampshire example below).
- Enrollment in CHIP (see Utah example below).
It’s important to note that states use different terminology, definitions, population denominators, and timeframes on their dashboards making it difficult to compare one state’s data to another. In some instances, the data displayed on state dashboards also varies from what states include in their monthly reports to CMS (see Georgetown’s State Unwinding Renewal Data Tracker for a summary of states’ monthly CMS reports).
Another cause of variation in the types of indicators reported across states is that states began disenrolling people from Medicaid in different months. For example, Arkansas resumed eligibility determinations in April 2023, and as of October 9th, the state indicated that it had fully completed its statutorily required six-month unwinding process. In contrast, Oregon started initiating procedural terminations in October and plans to take 10 months to complete eligibility redeterminations. Data reporting and interpretation across states is further complicated by the announcement from CMS on August 30, 2023 that 29 states and D.C. had been making ex parte renewal determinations on a household, rather than an individual level as regulations require. This caused some states to pause procedural terminations, reinstate coverage and/or implement temporary extensions for renewal.
Unwinding Indicators & Disaggregated Data Reported by States
Few states are reporting disaggregated data on their dashboards. The most common breakdowns that states are providing are by age and geography (typically by county). Although CMS only requires states to report data by modified adjusted gross income (MAGI) and non-disability applications versus disability applications, additional data breakdowns by age, race, ethnicity, and program type can elucidate important trends about the disproportionate impact of unwinding on groups that have been economically or socially marginalized. (See the state dashboards below for examples of disaggregated data reporting).
Visit the SHVS Expert perspective to view examples of state unwinding / insurance dashboards in the following states: Arizona, Colorado, Indiana, Massachusetts, Minnesota, New Hampshire, Oregon, Utah, and Washington.