When a federal public health provision related to the COVID-19 pandemic ends March 31, so will a requirement that Medicaid programs keep people continuously enrolled.

Starting April 1, continuous enrollment will no longer be automatic, and the state will be checking whether current Medicaid members are still eligible and ending coverage for those who are not.

The state Department of Human Services, which administers Medicaid, hopes to make the transition as seamless as possible.

At the same time, Medicaid enrollment is at a historic high in Hawaii because of this provision, according to DHS. More than 465,000 people are currently enrolled in Medicaid, representing roughly one-third of state residents and including more than half of the state’s keiki.

Since March 2020, Medicaid enrollment jumped 42% with more than 138,000 new enrollees.

To prepare for this “unwinding,” the department’s Med-QUEST Division is asking members to update their contact information and be on the lookout for a pink envelope in the mail, starting in April.

“We emphasize to members that it is very important to update their contact information with their health plan and encourage them to respond to all Med-QUEST/Medicaid communication in a timely manner to ensure continuous coverage,” said Judy Peterson, Medicaid director and Med-QUEST administrator, in a news release.

In March, letters will go out informing Med-QUEST members when they are scheduled for redetermination, with details on eligibility status to come in a follow-up pink letter.

This pink letter, sent in a pink envelope, will be sent to members a month prior to the month of renewal — as early as April for May renewals, for instance, and as late as March 2024 for April 2024 renewals.

These renewal notices will be spread out evenly across 12 months due to the sheer number of members.

Medicaid, which is run with federal and state funds, provides health care coverage to eligible children and their parents, pregnant women, seniors, the blind or disabled, and those in nursing homes. It is usually renewed annually.

In March 2020, Congress enacted the Families First Coronavirus Response Act Opens in a new tab, which required that Medicaid programs keep people continuously enrolled through the end of the month during the COVID-19 public health emergency.

States had to meet this requirement in order to qualify for enhanced federal funding, according to the Kaiser Family Foundation.

On Dec. 29, Congress passed the Consolidated Appropriations Act, setting March 31 as the end date for the continuous enrollment provision, along with a phase-down of enhanced federal funds through the end of the year. Starting April 1, states can resume Medicaid disenrollments.

The foundation estimates that 5 million to 14 million people will lose Medicaid coverage with the end of this provision. Those who moved since the start of the pandemic or with limited English proficiency or disabilities may be at greatest risk.

In Hawaii, DHS did not have a precise estimate of how many people stand to lose coverage, but said its Med-Quest Division wants to “assure people that their Medicaid coverage will remain active until their case is up for renewal.”

The situation is unprecedented, said Meredith Nichols, deputy Medicaid director and assistant administrator for Med-QUEST, but the entire process will take place over 12 months and not all at once.

“There is a lot of work ahead,” she said. “That’s part of why we want to reassure people there’s no need to panic.”

During the public health emergency, DHS said, no members were disenrolled unless they had requested their coverage be terminated or been verified to have moved out of state or died.

Some examples of why people could lose Medicaid eligibility in April include an increase in income, a new job with employer-provided health care or changing circumstances. Med-QUEST staff will help connect those no longer eligible to affordable coverage on the healthcare.gov marketplace.

Hilton Raethel, president and CEO of the Healthcare Association of Hawaii, said the transition period will be challenging for the industry.

“We do believe there are quite a few people who will no longer qualify,” he said.

At the end of the yearlong redetermination process, HAH anticipates the number of members eligible could fall below 400,000, he said, but that is just an estimate.

“The bigger issue with the redetermination is figuring out — from a hospital or doctor’s perspective — do they have Medicaid or do they have commercial insurance?” he said.

There will be some guesswork figuring out who pays, because the patient might not know.

Keali‘i Lopez, AARP Hawaii state director, is concerned that those who have gotten used to automatic renewal might miss those letters and subsequently lose their health care coverage.

Medicaid covers mostly health care services and some dental services for some of AARP’s members.

“So the issue now is for them to understand that’s not going to continue, make sure they check their mail and take steps to ensure they renew,” Lopez said. “One of the worst things that can happen is for someone to lose their coverage.”

AARP Hawaii has already worked with its aging network partners to make sure kupuna are aware of this. Caregivers who take care of paperwork should also be aware of renewal requirements.

Of those enrolled in Medi­caid in the state, about 20% are ages 45 to 65, and about 10% are ages 65 and older, according to data from the Kaiser Family Foundation.

Med-QUEST will first seek to renew a member’s eligibility using available data, DHS said. If so, the pink notice will inform the member of renewed coverage and that no further action is needed. If not, the member will be asked for additional information listed in the letter.

If Medicaid coverage is no longer needed, members should inform DHS by calling 800-316-8005.

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Med-QUEST asks members to:

>> Update contact information at Medical.mybenefits.hawaii.gov or by calling the number on the back of their insurance card.

>> Starting in April, look for a pink envelope with a pink letter and eligibility renewal instructions. This letter might require a response in order to maintain health coverage.

>> A member who is no longer eligible will be notified when their enrollment will end as well as how to appeal.

>> People who need coverage but no longer qualify for Med-QUEST should check with their employer for health insurance coverage eligibility. Information on other health care coverage options is available from healthcare.gov or 800-318-2596.

>> Those who no longer need QUEST (Medicaid) should inform DHS at 800-316-8005 (TTY/TDD 711). Visit medquest.hawaii.gov to learn more.