41% of Utah CHIP recipients lost coverage in May due to government reversal

More than 6,200 children in the Children’s Health Insurance Program in Utah lost health care coverage at the end of May as their cases were closed due to a reversal of authorization by the federal government, an advisory committee said this week.

Families can still get the health care coverage back but need to reapply as soon as possible.

The closure of 2,892 cases in the Utah CHIP system resulted in the termination of insurance for 6,264 children. The closure dropped coverage for approximately 41% of the 15,207 kids receiving benefits in Utah during the month of May, the CHIP Advisory Committee confirmed in a public meeting on Thursday.

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The children’s loss of coverage came after the federal government's Centers for Medicare and Medicaid Services reversed a decision allowing CHIP cases to remain open and suspend premiums due to the pandemic.

“We, early in the pandemic, tried to mimic what Medicaid was doing and keeping cases open. That seemed appropriate to us,” said Jeff Nelson of the CHIP Advisory Committee.

“So the state of Utah filed an emergency state plan amendment with CMS and they signed that with us — to keep the CHIP cases open,” he said.

Due to the federally declared public health emergency, Medicaid limited or waived premiums and prohibited agencies from terminating coverage for most recipients until the end of 2021.

The request, which was granted by CMS in March 2020, made the same policy apply to CHIP.

“We stopped charging premiums for the CHIP children in order to keep the benefits open,” Nelson said.

“It was about November of last year when we started getting inklings from CMS that they felt that they had overstepped their authority in doing so,” he said.

The state and federal government launched into talks about what to do next.

The redesigned plan allowed Utah to keep waiving premiums on CHIP insurance, but did not allow the state to grant any coverage without recipients resubmitting verification of their eligibility, Nelson explained.

Lost in the mail

Normal CHIP renewal rules were supposed to return to Utah during April, but the state scrambled to notify families.

Ironically, Nelson said, waiving premiums meant that families were not contacted quarterly to pay their bills during the pandemic, which made notifying them about the reverification requirement more difficult.

“We know that CHIP and Medicaid families tend to move; they tend to be fairly transitory,” Nelson explained. “So we may have lost touch with several.”

Due to constantly changing health care rules, the state also sent out several incorrect notices that may have trained people to ignore them, Nelson added.

The state sent out notifications of the change via paper mail and email throughout April and May.

Nelson estimates that 375 CHIP insurance cases — equal to coverage for approximately 700 children — were closed for legitimate reasons, such as moving from the state or gaining enough income to no longer be eligible for CHIP. Increased eligibility for Medicaid may have also resulted in kids moving from CHIP to Medicaid.

The remaining 2,143 case closures — resulting in the loss of insurance for approximately 4,000 Utah children — are a wild card.

“We don't know if they're eligible or not; we have no idea. They had not completed their renewal,” Nelson said.

The paper mail notifications and the short window to reapply quickly came under fire during the public meeting.

“Some families received their closure notification on the same day they received the notification that they needed to reenroll,” said Jessie Mandle, a senior policy analyst at Voices for Utah Children.

A community partner to Voices for Utah Children notified Mandle that three of the five CHIP recipients the office worked with received both notices on the same day.

Utah Department of Health’s Indian Health Liaison Melissa Zito pointed out that 44% of American Indians in Utah lost CHIP coverage in May, and that reservations only receiving mail once or twice a week may have contributed to the drop-off.

“There's a communication breakdown where people aren't getting those renewal notices on time,” said Emma Chacon, the operations director at the Division of Medicaid and Health Financing in Utah.

The CHIP advisory committee was surprised by the late notices.

“We do want to make sure that we're treating people fairly,” Nelson said. “That's not appropriate and that's not our intent.”

How to get coverage back

Families should have received notification of their account closures around May 20, and have until the end of the month to resubmit verification so that their coverage has no lapses, Nelson said.

Michelle Smith, assistant bureau director for Medicaid policy in Utah, stated that due to the exceptional circumstances, the state can extend the review process so families can reapply until the end of August without starting a new application from scratch.

Families should still apply for renewal by the end of the month, though, if they want to avoid lapses in their coverage.

“We do not allow retroactive coverage,” Smith said, noting that unlike Medicaid, CHIP coverage can only extend back to the first day of the month that a family submits an application.

“If anyone comes back in the month of June — and they're still eligible — we'll revert their case to open and essentially, at the end of the day it will look like they were open all this time,” Nelson said.

After August, families will have to reapply from scratch, but applications are open year-round.

Families can begin the renewal process or start an application for CHIP by going to jobs.utah.gov, the state's CHIP website, by checking their online CHIP portal, or by calling the state health care helpline at 211.