The state of New Jersey has been ordered by the U.S. Department of Health and Human Services (HHS) to pause disenrollments from their Medicaid and Children’s Health Insurance Program (CHIP) programs and reinstate coverage for thousands of residents who lost it due to a glitch uncovered several weeks ago.
According to HHS, the Centers for Medicare & Medicaid Services (CMS) alerted all states about a potential state systems issue where systems were inappropriately disenrolling children and other enrollees, even when the state had information indicating the person remained eligible.
This process is meant to make it easier for beneficiaries to renew their coverage and aims to help keep eligible people enrolled. However, CMS found that some renewal systems were evaluating redeterminations by family instead of by individual, leading to improper coverage losses.
As a result, New Jersey and 29 other states found to be having this systems issue were ordered to pause procedural disenrollments for impacted people unless they could ensure all eligible people are not improperly disenrolled due to this issue.
Nearly 500,000 children and other individuals from across the country who were improperly disenrolled from Medicaid or CHIP will regain their coverage, and many more are expected to be protected from improper disenrollments going forward.
No exact number was provided for affected members in New Jersey but officials estimate it to be less than 10,000 people.
As earlier reported by TLS, according to figures provided by the New Jersey Department of Human Services, between April 1st and June 30th, 500,794 NJ FamilyCare members had their renewals initiated, and 109,575 of those, or 22%, have so far been renewed.
In March 2020, the federal government temporarily waived Medicaid and Children’s Health Insurance Program (CHIP) requirements to help prevent people from losing health coverage during the pandemic.
State-run Medicaid programs were required by federal law to restart eligibility reviews by April 1 under the federal FY 2023 Omnibus spending bill passed by Congress and signed by President Biden in late December of 2022.