Experts say there could be several reasons for people to come off the Medicaid rolls, and one of those is an administrative process that sought to weed out people whose incomes are too high to qualify.
That process requested via mail that current Medicaid enrollees — who are known for moving regularly because of chronic poverty issues, and thus might have been hard to reach — verify their incomes for the Department of Vermont Health Access if they wanted to keep their insurance.
According to data from the Joint Fiscal Office, Medicaid enrollment peaked around January 2016. One year later, the office projects that enrollment has gone down as follows: adults older than 65 or with disabilities, by 6,210 people; low-income adults, by 7,794; blind or disabled children, 753; and low-income children, 2,517.
The Joint Fiscal Office data also suggest that thousands of low-income adults have moved over to commercial insurance through Vermont Health Connect, the state’s online medical insurance portal. The number of Vermonters getting help from the state to pay for their insurance on the exchange increased from 14,893 in January 2016 to 17,915 in 2017.
The reductions in Medicaid enrollment come after a period from January 2014 to December 2015 during which the Department of Vermont Health Access, which administers Medicaid, was automatically re-enrolling people while focusing on solving problems plaguing Vermont Health Connect.
During most of those two years, Vermont Health Connect did not have the technical capacity to process requested changes to people’s insurance plans — such as their incomes, the birth of a child, marriage or divorce — which all affect their Medicaid or commercial coverage. The state also had trouble getting access to the right tax and wage data to independently verify a person’s income.
Because of these issues with Vermont Health Connect, the federal government, which pays for about half of Vermont’s Medicaid program, gave the state a waiver allowing the Department of Vermont Health Access to automatically re-enroll people without reassessing their eligibility.
The Department of Vermont Health Access finished one annual cycle of redeterminations in October and completed another one Tuesday. Going forward, the redeterminations will be completed monthly, the department says.
The Legislature, which for years has struggled with Medicaid caseloads driving up state spending, has since banked more than $20 million in savings for the state and federal government in the current fiscal year.
In the Budget Adjustment Act passed Friday, the Legislature is using $18.4 million in total program savings, including $8.4 million in savings from Vermont’s general fund, to help balance the fiscal 2017 budget.
“Some of it might be that utilization (of Medicaid services) is lower, but a lot of it is driven by caseload,” Kitchel said.
She said it’s not clear if the state could have saved money earlier, because while enrollment was piling up, the Vermont Health Connect system was not able to process changes in factors that affect eligibility. In addition, people who asked to be removed from the Medicaid system were kept on the rolls.
House Speaker Mitzi Johnson, D-South Hero, said there could have also been people who were enrolled in Medicaid but weren’t going to the doctor, so when they were taken off the state didn’t save any money.
Additionally, she said some of the Medicaid patients could have simply been dropped because they moved. She said the state sent requests for income verification by mail, and low-income people tend to move frequently.
“The last address that Medicaid had could have been three addresses ago,” Johnson said. “They could have been homeless for a while and maybe just found a place.”
Stephanie Barrett, the associate fiscal officer at the Joint Fiscal Office, said adults using a Medicaid program because of a disability are most responsive to requests to verify eligibility because they use health care services so much.
“The folks who are just income-eligible and use fewer services, and may have more chaotic lives than the average person, they may still be eligible, but they time out … when they don’t respond in time,” Barrett said.
Cory Gustafson, the commissioner of the Department of Vermont Health Access, said it’s important for “program integrity” that “people who are eligible for the program are on the program.”
The department is now performing redeterminations monthly. “Not doing those redeterminations for the couple of years when we had the waiver … was obviously not the best in terms of program integrity,” Gustafson said.
