South Carolina’s Medicaid Enrollment Down After New Re-Evaluation Process Implemented

The number of people enrolled in South Carolina's Medicaid program has dropped by about 70,000 since February, possibly as a result of changes made to the eligibility verification process, the Charleston Post and Courier reports. The state implemented an automated eligibility re-evaluation process in February to replace a manual system that required state officials to evaluate beneficiaries' updated financial information and manually drop anyone who did not meet the program's requirements. If their eligibility status had not yet been evaluated, the beneficiaries retained coverage. The automated system sends out letters and forms to enrollees 60 days before the anniversary of the date they first enrolled in Medicaid, followed by a second letter mailed 10 days before the anniversary warning beneficiaries that their Medicaid coverage will be terminated if the form is not completed and returned on time. Since the state Department of Health and Human Services sent its first 60-day notices in February, it has sent notifications to about 276,000 beneficiaries; 130,000 were dropped from the program. Of those who were dropped, 60,000 have reapplied. While dropped beneficiaries can reapply to receive coverage, some are concerned that beneficiaries may be turned away by physicians and clinics before they are reinstated, the Post and Courier reports.

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Officials say they suspect the reason for the sharp decline in Medicaid enrollment is that people are failing to return the forms. "If we had a robust economy and people were going off Medicaid, that's great news for South Carolina, but that's not happening," Sue Berkowitz, executive director for the South Carolina Appleseed Legal Justice Center in Columbia, said. So few people initially responded that state officials temporarily shut down the system in April to make sure the letters were getting out; the system resumed operations in May when officials were satisfied that the results were accurate. However, a poll conducted by Select Health, a Medicaid HMO, found that 50% of beneficiaries who were dropped did not realize the process had changed, 25% returned their forms and 25% did not receive the forms (Maze, Charleston Post and Courier, 8/13).