A massive post-pandemic effort to redetermine eligibility for millions of New Yorkers enrolled in public health insurance officially wrapped up on July 31, 2024, but the lessons gleaned from this unprecedented “unwinding” will go far beyond the 14-month process.
Data tracking renewal outcomes throughout New York’s unwinding period offer a glimpse into potential gaps in coverage, population health trends, and budget implications. And, perhaps most importantly, they can support long-term policies to prevent eligible New Yorkers from losing coverage.
With each of these ends in mind, United Hospital Fund’s Medicaid Institute has added illuminating unwinding datasets to Public Health Insurance Dashboards on the UHF website. As with all graphs on the UHF dashboards, the new additions make public data more accessible and useful for those across the state.
“Anyone can access these data, but they are not always presented in ways that are easily digestible or conducive to observing trends,” UHF Senior Research Analyst Alexis Simonetti, MPH, said. “Stakeholders may not have time to comb through these data, so we make our dashboards publicly accessible to help inform stakeholders and advocates in their efforts to expand and strengthen public health insurance.”
Click Here to View the Public Health Insurance Dashboards
The new “Tracking the Unwind” graphs include the rate of successful renewals by each New York county, an interactive graph displaying program transitions for those who were due to redetermine their eligibility for public insurance, as well as a cumulative and monthly view of renewal outcomes.
The county-level graph, UHF staff note, can help identify regional differences in renewal rates and identify geographies that need more support. Program transition data—which tracks those who transitioned to another program after their renewal—can inform both budgetary and population health implications given the varying degrees of coverage and federal reimbursement rates across Medicaid, CHP, and EP.
In terms of using the unwind data to make long-term changes to the public health marketplace, New York has already seen some success with what are known as e14 waivers. 1902(e)(14)(A) waivers, commonly referred to as e14 waivers, have the potential to lift regulatory barriers during the redetermination process.
During the unwind, New York was granted 10 such waivers by the federal Centers for Medicaid and Medicaid Services (CMS) to provide more flexibility in their renewal efforts. These included several waivers that allow for “ex parte” renewals, also known as auto renewals, that redetermine eligibility with agency data rather than having the individual manually fill out a renewal form. Data show that these waivers significantly decrease “procedural disenrollment,” which occurs when eligible individuals lose coverage because they did not submit a form, were not able to be contacted, did not receive paperwork, or submitted a form incorrectly. Procedural disenrollment can also occur for other administrative reasons.
New York State, which used more ex parte waivers than 41 other states, had the second-lowest rate of procedural disenrollments in the country, according to unwind analyses by the Urban Institute from June to November 2023.
With the help of unwind data, New York officials are working to extend all 10 of their e14 waivers indefinitely, and CMS has so far agreed to extend the flexibilities through June 2025.
"Under normal circumstances, beneficiaries need to be recertified for their coverage every 12 months... By making these e14 waivers permanent, New York State can increase the number of people eligible for ex parte renewals and thus decrease the rate of people who lose coverage for procedural reasons,” UHF Medicaid Institute Director Alexandra Brandes, JD, MPH, said. “Ex parte or auto renewals are the easiest way for an individual to have their coverage renewed.”
In addition to waiver efforts, the state is assessing unwinding data to uncover other ways to improve the renewal process and making it easier for Medicaid members to more efficiently transition to other forms of insurance. The study, Medicaid Unwinding in New York (MUNY), is funded by United Hospital Fund, the New York State Department of Health, and Robert Wood Johnson Foundation.
It will be led by a team of researchers at Weill Cornell Medicine, in collaboration with experts at the Harvard T. H. Chan School of Public Health. Researchers will survey Medicaid enrollees in New York after their redetermination to examine their awareness of the unwinding, barriers to re-enrollment, availability of alternative coverage, and other enrollment outcomes.
Aside from its unwind data, UHF’s dashboards include graphs on annual public health insurance enrollment, Medicaid enrollment cumulatively and by county, children’s enrollment trends, Medicaid enrollment by eligibility group, Medicaid spending data, and historical Medicaid enrollment data.
Established in 2005, UHF’s Medicaid Institute provides information and analyses examining New York’s Medicaid program to help all stakeholders build a more effective health care system for low-income New Yorkers. It is a key component of our focus on supporting universal, affordable, comprehensive health insurance coverage and universal equitable access to services.
All the Medicaid Institute’s public health insurance dashboards can be found here.
