In recent months, seemingly dramatic headlines like “Thousands of Alaskans on Medicaid could lose coverage in the coming months” have popped up, frightening many into thinking that vulnerable populations such as children will lose Medicaid coverage. But this couldn’t be further from the truth. Instead, all states are restarting a process known as redetermination, which is simply the ongoing function of determining who is eligible for this government-funded health coverage program. Alaska needs to expedite this process so that the state doesn’t continue to pay for people who are no longer eligible.
During the COVID-19 pandemic, even if Medicaid enrollees became ineligible, the federal government prohibited states from removing them from the program. Now that the federal emergency has ended, Alaska has begun the work of identifying and removing unqualified individuals, which will ensure that program funds are spent on those who actually qualify for assistance.
Typically, this process occurs annually. For many years, states have regularly checked Medicaid rolls to ensure that only those entitled to assistance receive it. Enrollees who become ineligible, such as those who move out of state or have an increase in income — from starting a new job, receiving an inheritance, or winning the lottery, for example — are removed from Medicaid and provided information about other insurance programs and federal taxpayer-funded assistance. This regular redetermination process keeps ineligible individuals from utilizing Medicaid funds that would be better spent on the truly needy who are eligible for the program.
With Alaska’s fiscal deficit, the state should be looking for all possible ways to be cost-effective.
With the end of the federal emergency, Alaska is now allowed to restart the redetermination process. Because there is a multi-year backlog, there are many more ineligible people on the Medicaid rolls than was typical pre-2020. Nationally, it’s estimated that there are over 18 million people currently on Medicaid rolls who are ineligible for the program. Alaska Policy Forum has reached out to the Alaska Department of Health (DOH) for information regarding Alaska-specific numbers but has not yet received a definitive response. Because having unqualified individuals on Medicaid requires additional state funds, it’s important that this process be undertaken as quickly and efficiently as possible to reduce the burden on Alaska’s budget.
While there are a variety of factors that influence how well DOH will work through the redetermination process, at the very least, the state should prioritize reviewing those most likely to be unqualified. According to the Paragon Health Institute, these groups of people should be prioritized:
People who have indicated to the state that they have had a change in circumstances, such as moving out of state or an increase in income.
People who have not responded to the state’s outreach efforts for several years. This means that they have not filed for any Medicaid services and have not provided updated contact information to the state.
All other able-bodied adults, “because they are most likely to experience frequent changes in circumstances.”
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The state has implemented processes to ensure that eligible individuals are not removed from Medicaid. Enrollees will be able to appeal the process if they believe the department made a mistake during the eligibility check. Additionally, according to the Urban Institute, almost 99% of ineligible individuals removed from Medicaid rolls in the next year will qualify for other types of health coverage, including federal taxpayer-funded programs.
Most states, including Alaska, have reported that state government will take approximately 12 to 14 months to finish the redetermination process. Six states, however, plan on completing the process in one year or less, and Arkansas estimates finishing in only nine months. Alaska should absolutely be able to complete this process faster than is being projected, considering the small state population.
With Alaska’s fiscal deficit, the state should be looking for all possible ways to be cost-effective. Completing the Medicaid redetermination process in a more expeditious manner by prioritizing specific groups of enrollees is the right thing to do. Doing eligibility checks as quickly as possible will help with state finances, reduce potential fraud or abuse of the system, and preserve Medicaid funds for the truly needy.
The views expressed here are those of the author.