Many in Eagle County losing Medicaid coverage due to procedural errors

Since April 2023, nearly equal numbers of Coloradans have been disenrolled and renewed from Medicaid as the government unwind of continuous coverage progresses.

During the pandemic, the government suspended the annual Medicaid renewal process, ensuring continued coverage for all who qualified. However, following the declared end of the COVID-19 public health emergency, the government began terminating the practice. Starting in March 2023, notices were issued to individuals enrolled in Medicaid that they would once again have to redetermine eligibility on an annual basis starting his year.

“This change puts people at risk of having a gap in their health insurance coverage if they do not renew on time or do not complete their renewal packet correctly,” said Kyler Hijmans, a family nurse practitioner at Vail Health.

While Colorado’s unwind period will last through April 2024, Eagle County’s Department of Human Services is urging residents to look at their eligibility sooner rather than later.  

According to independent health policy research organization KFF, 249,000 Coloradans were disenrolled from Medicaid during the redetermination process, while 251,900 had coverage renewed as of Oct. 26, 2023.

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 “Since June of 2023, when people started losing their coverage, we have already seen a decline in Eagle County enrollment for Medicaid of about 10% (going from 9,484 individuals enrolled in Medicaid in Eagle County in June to 8,511 in September),” reported Michelle Dibos, the deputy director of economic services in the Eagle County Department of Human Services.

While many were disenrolled for a change in eligibility — namely, a change in their employment or financial situation — a vast majority are for procedural reasons.

In Colorado, KFF reported that this was the case in 69% of the disenrollments. According to the Colorado Department of Health Care Policy and Financing, the number of procedural denials has nearly doubled, increasing from an average of 12% pre-pandemic to around 26% currently.

“This is concerning because it means that many of the people who are being disenrolled from Medicaid may still be eligible for coverage,” Hijmans said.

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Dibos reported that there are several common procedural denials they’re seeing in Eagle County.

“This may include not submitting necessary documentation or verifications, not signing your renewal packet, which is a new requirement, or not taking action to renew on time. We are also seeing many people who have changed their address but have not updated their contact information, so we are unable to reach them to notify them of their upcoming renewal,” she said.

Because of this, Dibos and the county department are encouraging anyone enrolled in Medicaid to check and update their contact information in the Colorado PEAK portal.

“It’s very important that every person who is enrolled in Medicaid updates their contact information and preferred method of communication (mail, email or text message) so that Health First Colorado can contact them when it’s time to renew,” Hijmans said.

Open Enrollment

While individuals can apply for Medicaid anytime throughout the year, the typical open enrollment period starting on Nov. 1 marks a good time to review eligibility and apply. Especially for those who are at risk of losing their Medicaid coverage during the unwind period, “this is the time to look at what your options in the open marketplace are,” Dibos said.

If individuals are denied coverage through Medicaid, they still have opportunities for coverage.

“Outside of Health First Colorado, Colorado’s Medicaid program, there are other insurance options available through the open marketplace via Connect for Health Colorado. The open enrollment period runs Nov. 1 through Jan. 15. These dates are important because they are the only time when people can generally enroll in health insurance,” Dibos said. “Outside of these dates, people are only able to enroll when they experience a “qualifying life event”, such as getting married, having a child, or losing your job, resulting in the loss of your health insurance.”

Outside of Medicaid, there are discounts and tax credits available based on similar eligibility requirements. However, to access many of these — which are available through the Connect for Health Colorado open enrollment — you need a denial letter from Medicaid first.

“That’s why it’s important to potentially apply now during open enrollment season so you can get those discounts for the marketplace,” Dibos said.

Resources available

In Eagle County, there are several resources available to help with both open enrollment and Medicaid enrollment.

Vail Health is a Certified Application Assistance Site in the state, which Hijmans said makes the organization “authorized by the Colorado Department of Health Care Policy and Financing to assist residents of Colorado with applications for medical benefits.”

Since 2021, when Vail Health’s community outreach team began this work, it has helped 695 people enroll in Medicaid, Hijmans said.

The team’s community health specialists arrange meetings not only at the hospital but also at community-based locations. It also works with Eagle Valley Community Foundation’s MIRA Bus to “provide walk-in services for anyone who has questions about Medicaid enrollment or would like to apply,” Hijmans said.

Individuals in need of assistance with Medicaid applications can reach the Vail Health Community Outreach Team by emailing CommunityOutreach@vailhealth.org or calling 970-422-3039.

In addition, the Eagle County Department of Human Services can help individuals through the application process and with accessing the online Colorado PEAK portal. Representatives are available to help at 970-328-8888.

While individuals can also contact private health insurance brokers to help with enrollment through Connect for Health Colorado, Mountain Family Health Centers also has bilingual outreach specialists that can help people access their options. In Eagle County, Mountain Family has locations in Gypsum and Avon, with more information available at MountainFamily.org/Health-Insurance.