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State officials warn that large-scaled Medicaid disenrollment could draw scams

Tom Byrne
Delaware Public Media

Delaware’s Department of Health and Social Services will start reviewing the eligibility of the more than 315,000 Delawareans enrolled in Medicaid on April 1st.

That figure grew by roughly 27 percent during the pandemic, during which the agency could only drop people for one of three reasons: death, moving to a different state or requesting disenrollment.

Over the coming year, DHSS will renew coverage for most of those people. Those living in long-term care facilities or with intellectual and developmental disabilities, for instance, will continue receiving coverage."

But the agency expects to find 40,000 to 60,000 people who are no longer eligible, leaving them to find other health insurance options – and, according to state officials, creating an opportunity for large-scale scams.

Insurance Commissioner Trinidad Navarro told Delaware’s Health Care Commission last week many dropped from Medicare will hurry to find a new health insurance plan, leaving them vulnerable to scams and misleading marketing.

“People are going to be singing up for things like 'skinny plans' that promise to cover essential health benefits, and we’ve learned from the past that that simply doesn’t happen," he said. "Fraudsters can’t wait for this to happen, and we’re going to see a significant increase in people being taken advantage of.”

Finance Secretary Rick Geisenberger says those expectations are based partially on the state’s run-ins with fraud operations during last year’s pandemic relief tax rebate program.

“We actually found Russian language stuff telling people to go to Delaware’s website," he said. "That’s how all that unemployment insurance money disappeared, too. So I have no doubt that the same thing will happen here to try to get people who are dropped from the rolls to send their money someplace else.”

DHSS and medical care providers plan to use as many forms of communication as possible to inform patients about the reviews and gather the necessary information to confirm their eligibility.

DHSS notes unless a person is part of a group considered especially difficult to reach — those in nursing homes, for instance — it will disenroll them if they don’t receive responses. Special enrollment periods will be available through the federal healthcare marketplace for those who lose Medicaid coverage.

The so-called "unwinding" of pandemic-era Medicaid coverage will continue through much of 2024. Federal rules prohibit states from disenrolling more than one-ninth of the population at once, and DHSS Secretary Molly Magarik told the Health Care Commission that her agency likely couldn't move any faster given the amount of work needed to review the eligibility of those currently enrolled. DHSS will begin by reviewing those who have gone years without a reevaluation of their eligibility; those who have applied for Medicaid more recently will be the last to be reviewed.

Though Delaware will continue to cover a larger-than-usual Medicaid population well into next year, the additional federal assistance available during the pandemic will end next January. DHSS has asked the General Assembly for both one-time and ongoing spending to accommodate the expanded Medicaid population after the federal assistance runs dry.

Paul Kiefer comes to Delaware from Seattle, where he covered policing, prisons and public safety for the local news site PubliCola.