More than 200K West Virginians lost Medicaid or CHIP over past year, most for a procedural issues

Over the past year, as the programs returned to pre-pandemic eligibility rules, more than 200,000 West Virginians were removed from the Medicaid or the Child Health Insurance Program, state data shows.

The vast majority of those disenrollments — 79% — were due to a procedural reason like failing to return a form re-enrolling in the program, according to an analysis of state data by the Center for Children and Families at Georgetown University. The remaining 21% of those who lost coverage were determined to no longer meet the eligibility requirements for the programs. 

Medicaid is a state and federal program that provides health coverage to low-income West Virginians as well as pregnant women, those with a disability and others. For three years during the COVID-19 pandemic, in order to receive enhanced funding from the federal government, states were prohibited from removing people from the programs, even though they may no longer meet eligibility requirements for the programs.

Over those three years West Virginia’s Medicaid rolls grew from 30% — from 504,760 in March 2020 to 656,269 in December 2022, according to health officials. The state Bureau for Medical Services began reassessing its Medicaid and CHIP rolls and removing people who no longer met eligibility requirements or failed to return a re-enrollment form in April 2023. The year-long process, commonly referred to as “unwinding,” was expected to be completed in March.

Ellen Allen, executive director of the advocacy organization West Virginians for Affordable Health Care, called the number of total procedural disenrollments — 79% — “stunning” and called on health officials to improve the renewal process. 

“It is essential that these West Virginians get re-enrolled so they will have access to affordable health care,” Allen said. “The enrollment process should become as easy and seamless as possible to avoid future interruptions for children and families.”

Over the past year, the state removed approximately 46,000 children from CHIP and Medicaid because of a procedural issue. Another 12,000 were determined to be ineligible for one of the programs. 

Rhonda Rogombe, health and safety net policy analyst for the West Virginia Center on Budget and Policy, said the unwinding process was “unprecedented on the national level” and said states had little time to put together their unwinding process, leading to a lot of errors nationally. 

To retain more eligible people, Rogombe said, the state should increase the number of people it enrolls on an “ex parte” basis, meaning using income and tax data to verify a person’s income rather than having them complete a form. 

According to the analysis by the Center for Children and Families at Georgetown University, 18% of West Virginians were re-enrolled on an ex-parte basis, compared with 41% renewed by filling out a form. 

Rogombe said she’s noticed an inverse relationship between the number of ex-parte renewals and the people who are denied for procedural reasons.

“The higher percentage of ex-parte renewals we have, the lower the procedural denial rate,” she said. “That’s because more people are being renewed before they have paperwork sent to them, therefore, they don’t really have the opportunity to not complete [the paperwork]. So I’d really like to see that continue to improve. It’s improved significantly in our state, but we have a ways to go with it.”

The state could also improve by making sure that recipients know where to go if they have problems and how to re-enroll in the program, she said. 

“They can [re-enroll] over the phone, they can do it via online, they can do it in person — making sure people are just connected to the resources available I think is a really big piece,” she said. Transparency through monthly data collection and sharing about the Medicaid renewals has been a big part of advocates knowing what’s going on and making recommendations for improvements, she said.

It’s unclear how many of the people removed from their health care but still eligible were re-enrolled in the programs and how many of them were enrolled in another type of health care coverage. The unwinding process likely contributed to an increased number of West Virginians enrolling in plans on the federal government’s health insurance marketplace, a policy analyst told West Virginia Watch earlier this year.    

The state Department of Human Services did not respond to questions for this story, including about the number of people enrolled in Medicaid now that unwinding is over. Sen. Eric Tarr, R-Putnam, and chair of the Senate Finance Committee, said state Medicaid enrollment was approximately 516,000 this month, down from about 667,000 in April 2023. 

The state Bureau for Medical Services has been criticized recently for leaving millions of dollars unspent that were supposed to provide services for people with disabilities. Medicaid faces a $147 million funding shortfall for fiscal year 2025. Gov. Jim Justice has said he would call a special legislative session sometime this spring to deal with lingering budget issues. 

Rogombe said Medicaid’s importance cannot be understated. 

“I hope that our legislative body and governor do the right thing and fully fund the program so it can continue to serve West Virginia families,” she said.