Definitions

Percent of Members Renewed Ex Parte: Medical eligibility reviews completed by the state without involving the Medicaid member directly. The state may use all available data sources to approve the eligibility for another year.

Percent of Members Renewed by Form: Medicaid members who are not approved via ex parte are sent a review form to provide the state with missing information to establish if the person is still eligible or not.

Percent of Members Closed - Determined Ineligible: The state has reviewed all eligibility criteria and the person no longer qualifies for Medicaid services.

Percent of Members Closed - Procedural: The state has not yet determined if the person is eligible or ineligible to continue to receive benefits, but the requested information was not provided by the due date.

Percent of Member Reviews Pended: Eligibility decisions have not yet been made for these members. Either more time was requested to return missing information or the information has not been processed by the state.

Background

The requirement to maintain Children's Health Insurance Program (CHIP) cases open by DWS ended in May 2021. Since that time, enrollment in CHIP has seen a steady decline. When the requirement to hold Medicaid cases open ends, it is suspected that many children that are disenrolled from Medicaid will be eligible for CHIP benefits. This chart shows how many transfers are occuring on a monthly basis. Medicaid children moving to CHIP include children who were receiving presumptive eligibility, had the limited COVID 19 coverage, purchased Medicaid (spenddown), or moved from another Medicaid program to CHIP.

Definitions

Presumptive Eligibility: Early access to Medicaid services based on simplified eligibility completed in a hospital or clinical setting.

HPE: Hospital Presumptive Eligibility

BYB: Baby Your Baby