Most people in NC who lost Medicaid health coverage in the last two months were cut for “procedural” reasons

North Carolina and other states are stripping government health insurance coverage from thousands of people who stayed on Medicaid rolls during the COVID-19 pandemic but may no longer qualify. 

More than 68,000 people lost Medicaid coverage in North Carolina in June and July. Of those, about 87% lost their coverage for “procedural reasons,” because they did not provide requested information, or because their caseworkers could not reach them. 

The state Department of Health and Human Services estimated earlier this year that up to 300,000 North Carolinians could lose full Medicaid coverage over 12 months. In a July telephone interview, DHHS Secretary Kody Kinsley said the department is sticking with that estimate. 

Before the COVID-19 pandemic, people insured under Medicaid had to have it renewed every year. Their income and life circumstances were reviewed annually to see if they still qualified.  

Beginning in March 2020, the federal government prohibited states from cutting people from Medicaid so they would have insurance during the public health crisis. 

The federal government pays most of the cost of Medicaid. During the months that the federal government told states to stop kicking people off, it gave states extra money to keep people insured. A federal budget bill passed in December triggered the end of that continuous coverage.

About 2.9 million people in the state have some Medicaid coverage, according to DHHS. 

Most people in the state have had their coverage renewed without any paperwork needing to change hands. The state uses electronic records, federal food assistance records for example, to check whether Medicaid enrollees still qualify. 

Doug Sea, senior attorney with the Charlotte Center for Legal Advocacy, worried before the renewals started up again that some people would lose their Medicaid coverage by mistake. 

He said Tuesday that he knows of one case where someone who did not get a renewal notice lost their coverage. That person’s coverage was restored, he said. 

“We have seen some cases that are problematic,” Sea said. 

The question about enrollees being dropped for procedural reasons is whether they are not getting notices about updating their information, or if they’re getting them, but don’t realize they have to respond, Sea said. 

The advocacy center reached a court settlement with DHHS last year over Medicaid terminations and benefit reductions that results in the center receiving its own reports on people who are losing coverage. Sea said the numbers they’re receiving show more people losing coverage than publicly reported.

Across states supplying enrollment information, 75% of Medicaid enrollees have lost coverage because of procedural reasons as of Monday, KFF reported. At least 4.6 million people had lost Medicaid coverage across 44 states and Washington, DC, according to KFF. State percentages of procedural disenrollments show a wide range, from 97% in New Mexico to 17% in Michigan.

North Carolina is doubling back to look at random samples of people who lost their coverage to see why it happened, Kinsley said. 

DHHS said in an email Tuesday that 60 days before their renewal date, recipients receive a notice that they can change their health plan. Most Medicaid recipients are enrolled in Medicaid managed care and have a choice of health plans. 

Beneficiaries are contacted by robocall, text and email each month as their renewal date nears to remind them to update their information online or with their county social service departments, DHHS said in the email. 

After people are terminated for paperwork reasons, the Medicaid health plans, regional government mental health offices, and primary care management groups contact them again to encourage them to provide requested information.

As the “unwinding” process continues, Sec. Kinsley is urging legislative leaders to allow Medicaid expansion to advance independent of a final state budget. Expansion would help some of those participants from experiencing a gap in their coverage.