When automatic Medicaid renewal policy established during the COVID era expired in 2023, new semi-annual enrollment requirements took its place. As a result, nearly a third of recipients lost their coverage—most due to procedural reasons, such as missing paperwork or failing to meet deadlines. To avoid mass procedural denials and coverage loss, the federal government partnered with four state agencies to increase automatic renewal ("ex parte") renewal rates.
A recent evaluation led by University of Michigan professors Pamela Herd and Don Moynihan found that reducing administrative burdens by automating Medicaid renewals helps eligible beneficiaries remain in the program and increases Medicaid coverage for those in need. The study, co-authored by researchers from Georgetown University and Cornell University, also emphasized that successful policies depend on states' capacity to implement them.
"The speed and size of the intervention's impact offer important lessons that go beyond the ‘unwinding,'" write the researchers. "Failing to renew Medicaid for procedural reasons is costly to people losing coverage … It is also costly to the state because eligible people disenrolled from the program frequently re-enroll, which is more expensive than renewing coverage."
Federal and state intervention efforts were successful in increasing renewals in California, New York, South Carolina, and Wisconsin. With better information and capacity, ex parte renewals increased by 21.6 percentage points, while overall renewals increased by 7.7 percentage points. Procedural denials decreased by more than 8 percentage points, eliminating the need for disenrollment paperwork and other administrative burdens associated with coverage denials.
While previous evidence on automatic renewals is limited and unclear as to its impacts, the study identifies federal assistance for state agencies as a key factor driving successful outcomes.
"The findings ultimately demonstrate that changes in administrative burdens are policy choices," the authors said. "Through policy implementation, states can influence how much the new Medicaid requirements lead to eligible beneficiaries losing coverage for administrative reasons."
Read "Interventions To Automate Medicaid Renewals Reduce Procedural Denials And Increase Coverage," authored by Pamela Herd, Eric R. Giannella, Jeremy Barofsky, Luke Farrell, and Donald Moynihan, in Health Affairs.
