Medicaid redetermination in Washington: July data and CMS letter

August 25, 2023

WSHA continues to monitor the Medicaid redetermination process with the Health Care Authority (HCA) releasing July data in their Apple Health client eligibility dashboard. In July, HCA reported that there were 2,164,370 Washingtonians eligible for the Apple Health program. This is a -3.81% change from June representing an additional 85,620 individuals who have lost coverage since the redetermination process kicked off in May. However, this total does not appear to include those who are actively seeking to reenroll with retroactive coverage during the 90-day reconsideration period.

HCA received a letter from CMS regarding a review of the state’s redetermination process in early August. In the letter to Washington state, CMS highlighted one area of concern related to the percentage of beneficiaries who were terminated for procedural reasons, such as not responding to a redetermination notification. In May 2023, 43% of beneficiaries were terminated from the Apple Health program for procedural reasons not relevant to their eligibility. CMS expressed concern that eligible Washingtonians, including children, might be losing their coverage unnecessarily.

CMS will be following up soon to ensure that this identified area of concern is addressed. All 50 states were reviewed on three sets of metrics: call center operations, percentage of beneficiaries terminated for procedural reasons, and MAGI application processing times.

For resources on the Apple Health renewal process, please visit WSHA’s Medicaid Redetermination in Washington state webpage. (Mary Storace)



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