Improving Ex Parte Renewal Rates: State Diagnostic Assessment Tool

Editor’s Note: In a new expert perspective prepared for the Robert Wood Johnson Foundation’s State Health and Value Strategies program, reproduced below, Manatt Health provides a table that states can use to examine current ex parte processes and identify and deploy additional strategies that could increase their ex parte rates. To download a copy, click here.

Background

Improving ex parte rates as part of the Medicaid renewal process is one of the most effective tools available to states to mitigate coverage loss for eligible individuals when the public health emergency (PHE) ends. The current Medicaid continuous coverage requirement enacted by the Families First Coronavirus Response Act prohibits states from disenrolling individuals from Medicaid for the duration of the PHE as a condition of accessing enhanced federal Medicaid funding.¹ When the PHE ends, state Medicaid agencies will need to conduct a full redetermination for all individuals with a pending Medicaid renewal.² This undertaking has significant health equity implications, as communities of color are expected to be disproportionately impacted by the unwinding effort.

Federal regulations require states to attempt to renew Medicaid enrollee eligibility through an ex parte process using all available data sources.³ If an individual’s eligibility is able to be verified ex parte, states are required to extend Medicaid coverage without any additional action from the enrollee. If the state is unable to determine an individual’s eligibility through an ex parte process, the state must send a new renewal form requesting additional information and/or documentation. Importantly, states are required to attempt an ex parte renewal process for both Modified Adjusted Gross Income (MAGI) and non-MAGI populations.⁴

There are tremendous benefits to enrollees and to states in maximizing eligibility redetermination through an ex parte process. For enrollees, they are more likely to retain their coverage; anytime a state sends a request for information to an enrollee, the likelihood increases that an eligible individual will lose coverage, either because they moved or because they cannot or do not respond to the requested information in a timely way. States can reduce administrative workload on an already taxed eligibility workforce. As states develop their unwinding policies and operational plans in readiness for the end of the PHE, improving ex parte rates should be at the top of their priority list.

The following table can be used by a state to examine current ex parte processes and identify and deploy additional strategies that could increase their ex parte rates.

Ex Parte Diagnostic Assessment Tool

_{¹ Families First Coronavirus Response Act § 6008(b)(3).}

_{² Centers for Medicare & Medicaid Services (CMS), SHO# 22-001, “RE: Promoting Continuity of Coverage and Distributing Eligibility and Enrollment Workload in Medicaid, the Children’s Health Insurance Program (CHIP), and Basic Health Program (BHP) Upon Conclusion of the COVID-19 Public Health Emergency,” March 3, 2022.}

_{³ 42 C.F.R. 435.916.}

_{⁴ Medicaid and CHIP Learning Collaborative, “Streamlined Eligibility and Enrollment for Non-MAGI Populations,” June 2015.}

_{⁵ Supra note 2.}

_{⁶ CMS, “Express Lane Eligibility Option,” February 2010.}

_{⁷ State Health Reform Assistance Network, “Using Supplemental Nutrition Assistance Program (SNAP) Information to Facilitate Medicaid Enrollment and Renewal,” Robert Wood Johnson Foundation, September 2016.}

_{⁸ The Medicaid and CHIP Learning Collaborative, “Medicaid & CHIP MAGI Application Processing: Ensuring Timely and Accurate Eligibility Determinations,” Spring 2019; CMS All-State SOTA Call, “Achieving Real Time Eligibility Determinations,” June 2015.}

_{⁹ 42 C.F.R. 435.916.}

_{¹⁰ 42 C.F.R. 435.916.}