Medicaid Unwinding is Not as Smooth as Some Had Hoped

The Pennsylvania Department of Human Services (DHS) is struggling with tech issues, persistent staffing shortages, and flawed procedures as it redetermines thousands for Medicaid and CHIP coverage due to the Medicaid Continuous Coverage Unwinding which began April 1, 2023. The ex-parte process for renewing of applications using existing data sources has garnered a very low success rate. Just 4% of Medicaid renewals have been done through the ex parte process, higher than only Texas and Wyoming. The federal government has been pushing states to use this method, which is considered to be more efficient for administrators and easier for benefit recipients, who end up with a lower chance of churning on and off of Medicaid rolls. As of Oct. 23, KFF Medicaid Enrollment and Unwinding Tracker reported 46% of PA disenrollments were due to procedural reasons, and 54% were deemed ineligible. DHS has also published demographic and county-specific unwinding data. Read more.