Letter to U.S. Governors from HHS Secretary Xavier Becerra on Medicaid Redeterminations
I am writing to follow up on my March 2023 letter regarding states’ efforts to return to pre-COVID-19 pandemic Medicaid operations. As full Medicaid renewals begin, it is critically important to ensure that individuals do not lose coverage due solely to administrative processes. I urge you to adopt all options that we have offered to help eligible individuals and families maintain their health coverage during this process and leverage all state partners to support individuals and families to complete renewal forms.
High-quality health care coverage is a prerequisite to having meaningful access to the health care system—something that provides peace of mind and security to every American family. The Department of Health and Human Services, through our Centers for Medicare and Medicaid Services, is closely monitoring changes in Medicaid and Children’s Health Insurance Program (CHIP) enrollment. I am deeply concerned with the number of people unnecessarily losing coverage, especially those who appear to have lost coverage for avoidable reasons that State Medicaid offices have the power to prevent or mitigate.
Given the high number of people losing coverage due to administrative processes, I urge you to review your state’s currently elected flexibilities and consider going further to take up existing and new policy options that we have offered to protect eligible individuals and families from procedural termination. I am pleased to announce several new options for states to consider adopting, such as allowing states to use their managed care plans to help beneficiaries complete these forms. These new options build on existing flexibilities we have already offered states, such as:
- Spreading renewals for all populations out over 12 months, which will provide more time to run a smooth process and prevent systems from getting backlogged. A smooth process reduces burden not only on individuals and families, but also on state eligibility systems. Taking the time to do the process correctly will ensure those eligible for continued coverage do not experience a gap in care and those no longer eligible easily transition to other sources of coverage.
- Maximizing the use of data sources, such as renewing individuals on the basis of their eligibility for other programs, such as the Supplemental Nutrition Assistance Program (SNAP) or Temporary Assistance for Needy Families (TANF). This will help reduce the need for some individuals to fill out and return a Medicaid renewal form.
- Partnering with managed care plans and using data available from the United States Postal Service to update people’s contact information so that they actually receive the renewal forms states are sending out.
These are just a few of the options that help to maintain coverage for eligible people – there are many more, and we welcome the opportunity to provide technical assistance to implement these policies.
A full list of available state strategies is available here.
In addition to these flexibilities, I encourage all states to partner with stakeholders on the ground to engage more directly with Medicaid and CHIP families. A recent survey of Medicaid enrollees found that two-thirds of people were not sure if their state was returning to regular Medicaid operations. We must all do much more to ensure that everyone with Medicaid or CHIP coverage knows that they must check their mailbox and/or email for a renewal form and return it immediately to maintain their coverage.
I urge you to work with local governments, community-based organizations, schools, faith-based organizations and leaders, grocery stores, pharmacies, and anyone else in your communities who can help people understand the Medicaid and CHIP renewal process. We have innovative examples of this engagement across the country. For example, in Illinois, Chicago Public Schools provide direct assistance to families renewing their Medicaid and CHIP coverage, including by sending information home with students and holding community and outreach events.1 I am asking that we redouble efforts, expand what is working and reach out even further to ensure that no eligible beneficiary experiences a loss in coverage that could have been avoided.
Any avoidable loss in coverage is concerning, but I am particularly concerned that children may lose coverage because their parents do not understand that even if they experience a transition in coverage, their children are very likely still eligible for coverage through Medicaid or CHIP. HHS is committed to doing everything in its power to ensure that our children have access to care they need. Even if parents think they are no longer eligible, states should ask parents to still fill out their renewal forms for their children. We also urge you to include messaging about Medicaid renewals through schools, early childhood programs, and summer camps to parents.
As you know, states must comply with federal rules regarding how they conduct Medicaid and CHIP renewals, and individuals must be afforded the due process to which they are entitled in order for states to continue to receive enhanced federal funding. We take our oversight responsibilities extremely seriously, and while we know that states are working hard to meet the federal requirements, we will not hesitate to use the compliance authority provided by Congress, including requesting that states pause procedural terminations under conditions outlined by the Consolidated Appropriations Act, 2023, should it be needed.
As Secretary of Health and Human Services, I am committed to making sure every American has access to quality, affordable health coverage. Our partnership is critical in making this a reality, and I urge every state to go above and beyond to keep eligible people covered. My team stands ready to help.
Thank you for your continued partnership.