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State Dashboards to Monitor the Unwinding of the Medicaid Continuous Coverage Requirement (Cross-Post)
September 9, 2023:
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 September 9, 2023.
The unwinding of the Medicaid continuous coverage requirement represents the largest nationwide coverage transition since the Affordable Care Act, with significant health equity implications. As states restart eligibility redeterminations, millions of Medicaid enrollees will be at risk of losing their coverage with some portion exiting because they are no longer eligible, some losing coverage due to administrative challenges despite continued eligibility, and some transitioning to another source of coverage. As part of this process, the Centers for Medicare & Medicaid Services (CMS) requires states to closely track and monitor the impacts of the resumption of eligibility redeterminations and disenrollments, and on July 28, 2023, CMS released the first batch of these data. CMS’ commitment to transparency is mirrored by calls from advocates and researchers eager to see how progress is being made as people enrolled in Medicaid have their eligibility redetermined.
Given the intense focus on coverage transitions during the unwinding and the delays and caveats of the CMS data, many states have published their own state data dashboards to monitor progress. Data dashboards are useful for publishing dynamic data that is in high demand. They allow states to make proactive decisions about what data to release and on what schedule and then organize that data in an easy-to-digest visual format that facilitates the interpretation of key trends and patterns at a glance. Given the intense interest in unwinding data to monitor the impact of coverage transitions, releasing data in this format also allows states to follow some specific best practices, including providing additional detail about definitions, timeframes, and state context that will be important for communicating the unique and specific circumstances that states are experiencing during unwinding. An SHVS expert perspective highlights best practices for states to follow when publicly reporting unwinding data.
States Publicly Posting Unwinding Data
To date, 42 states including the District of Columbia (D.C.) have publicly published 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 42 states currently reporting data:
- 21 are releasing state unwinding data online in either an interactive dashboard or static pdf format.
- Two states have only released copies of their required CMS Monthly Unwinding Data.
- 19 states are releasing 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 in a report to a legislature. Because these data are not being systematically reported, they are not represented in the map above.
SHADAC will continue to update this expert perspective as more states publish 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 42 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
- Number of cases terminated that are re-enrolled or reinstated in Medicaid
- Number of Medicaid cases sent to the Marketplace
- Enrollment in CHIP
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, five states began disenrollments in April and another 14 states began disenrollments in May. Also, CMS has allowed states to delay terminations for one month and conduct additional outreach.
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 program and geography (typically by county). Although CMS only asks 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.
Visit the SHVS Expert perspective for a selection of state dashboard examples including: Arizona, Colorado, Massachusetts, Minnesota, New Hampshire, Ohio, Oregon, Utah, and Washington.
