Cutting red tape for Americans renewing health coverage and government workers

The Department of Health and Human Services: Center for Medicaid and CHIP Services

Challenge

After the COVID-19 public health emergency (PHE) ended on March 31, 2023, many federal benefit programs’ continuous enrollment conditions ended. This meant that individuals on Medicaid and Children’s Health Insurance Program (CHIP) coverage needed to complete an annual eligibility renewal to maintain coverage. As a result, state agencies and government workers faced significant challenges as they tried to rapidly manage growing caseloads for tens of millions of Americans seeking to renew their health coverage.

Solution

USDS partnered with the Center for Medicaid and CHIP Services (CMCS) and state Medicaid agencies to rapidly implement more efficient and accurate renewal processes. The team interviewed state agencies and government workers and found that the legally required ex parte (automatic) renewal process was inefficiently implemented in many states. This process uses federal data and systems and state government data sources to renew eligible enrollees more efficiently, with less red tape and burden on state workers.

While some states were able to complete over 50% of their renewals through the lower cost ex parte process, other states were completing less than 10% of renewals through the ex parte process.

This insight indicated that improving the software that powered the ex parte renewal process in struggling states could yield significant time and cost savings for those states. It would be a win-win-win for eligible enrollees, state eligibility workers, and state agencies:

• Eligible enrollees would maintain continuous health coverage without unnecessary red tape and burdensome paperwork.
• Eligibility workers would need to process fewer paper submissions and could focus on more complex cases, improving accuracy and program integrity.
• State agencies would reduce their backlogs and costs while making their systems more compliant with state and federal law.

The USDS-CMCS team ran its first on-the-ground pilot in Michigan, where they worked with state staff and vendors to pull and analyze data showing how enrollees were moving through the states’ systems. Together, they found ways to better align the renewals software with state policy goals and integrate more data sources into the system. Once implemented, the changes improved system compliance, saved thousands of eligibility worker hours each month, and more than doubled the number of people being renewed with less red tape. Following this success and high demand from state agencies across the country, the USDS team and CMCS rapidly launched in-depth technical assistance for ten states across diverse geographies, populations including Wisconsin, California, South Carolina, Hawaii, Kansas, New York, New Jersey, Alaska, Nebraska, and Pennsylvania.

Impact

As of January 2024, partner states that have implemented changes with the USDS-CMCS team increased their monthly ex parte rates by an average of 21% and decreased their procedural termination rate by 10%. In 2024, these improvements are estimated to save over two million hours of state worker time and improve the experience of maintaining health coverage for millions of eligible Americans.

These changes have made ex parte software more accurate and improved state policymakers’ control over implementation—ultimately improving systems compliance. Reducing caseloads has allowed eligibility workers more time to focus on complex cases and improve program integrity.

While investigating state ex parte systems, USDS and CMCS also uncovered and fixed a significant common system error that impacted 29 states and was responsible for the improper loss of coverage for over 400,000 children and families in Medicaid and CHIP. As a result of this fix, improperly disenrolled people regained their coverage and retroactively had their healthcare coverage reinstated for their period of improper unenrollment.

Notably, many of these improvements to ex-parte systems and renewal processes will continue to benefit CMCS and states over the long term. More compliant and accurate state systems will continue to save millions of hours of state worker time each year and keep millions of eligible Americans in their health coverage with less red tape.

USDS delivered sustainable, long-term policy and delivery impact in the Medicaid enrollment process. View live results of the project at CMS.gov.

By the numbers