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As federal rules that kept states from dropping Medicaid recipients were unwinding last year, Utah saw a higher percentage of children losing their public health care coverage than most states, federal data shows.

According to data from the U.S. Department of Health and Human Services, 16% of Utah children previously enrolled in Medicaid lost that coverage between March and September of 2023 — well above the national average. The figure puts Utah among 11 states that had double-digit percentage decreases, and the sixth-highest disenrollment rate in the country.

Many children — and adults — who lost coverage are still uninsured, according to results from a survey the state sent to former Medicaid members.

That survey found 30% of members didn’t get health insurance through other means, and that just 4% of respondents had children now enrolled in the state-run Children’s Health Insurance Plan, or CHIP.

“Too many people have lost coverage and are still not covered,” said Matt Slonaker, executive director of the Utah Health Policy Project, an advocacy group.

The unwinding process, he said, has “shown what’s always been going on with the crazy churn” of people through Medicaid eligibility and is giving the state a chance to improve.

Jennifer Strohecker, the state’s Medicaid director, said Utah is “leveraging every resource” to do better.

High rates of disenrollment, especially for procedural reasons, showed the state has challenges connecting with Medicaid members and highlighted other obstacles those members face, she said.

“It’s a complicated process, and we have to be committed to improving that process,” Strohecker said. “We need to really support people where they’re at, and build tools and resources to help them overcome those barriers.”

Thousands of Utah kids lost coverage

Nationwide, about 88 million people — including about 33 million children — were enrolled in Medicaid as of last September, according to federal data.

That was down 4% for overall enrollment compared to March 2023. Among the millions who lost Medicaid coverage in those months were 2.3 million children.

Utah had 402,120 people enrolled in Medicaid as of September 2023, down 9% from March. That was a bigger proportional loss than all but 12 states and tied with North Dakota. Three neighboring states — Arizona, Colorado and Idaho — had higher disenrollment rates.

The state’s Medicaid population included 166,931 children as of Sept. 23. That was down 16% from March, as 37,283 children lost coverage.

Utah had the sixth-highest rate of Medicaid disenrollment among children between March and September.

Neighboring Idaho tied with South Dakota for the highest rate, at 27%. Arkansas, Montana and New Hampshire also had higher rates than Utah.

“Compared to [most] other states, Utah is bad,” Slonaker said.

Health plans have called the state’s unwinding process a “botched job,” he added, and didn’t expect the big declines in Medicaid enrollment.

Slonaker said he also didn’t expect the numbers to get better.

“Everything is indicating that we’re going to see an uptick in the number of uninsured, low-income people in the state of Utah,” he said.

Strohecker said disenrollment rates in December were consistent with monthly rates in the time frame covered by the federal data. The state has been asking why those numbers are so high since September, she said.

‘State-initiated red tape’

Slonaker said it comes down to communication. The unwinding process, he said, has shown Utah has a “tricky process” for finding individuals and families eligible for Medicaid, and then keeping in touch with them once they’re eligible.

The state needs to modernize its outreach and communication, he said, and adjust policies to let people maintain eligibility.

Utah policymakers are against federal red tape, he said, but there’s “state-initiated red tape” keeping people from leveraging Medicaid as a benefit and getting a leg up.

Heather Howard, director of the State Health and Value Strategies program at Princeton University, said “numbers are concerning everywhere” and there aren’t deep years of research yet to show what works to improve them.

“My recommendation to states is, ‘You’ve got to try everything,’” she said.

State Health and Value Strategies is a program focused on helping states transform health care systems to make them affordable, equitable and innovative. In regular ”States of Unwinding” posts, the program has highlighted examples of what states are doing to minimize coverage losses throughout unwinding.

A recent post featured a surge campaign in Georgia to keep children enrolled, a waiver in North Carolina to extend eligibility for children for a year (something Kentucky also did) and successes using automation to renew members in Arizona.

The biggest thing states need to do is improve communication, Howard said. “You have to fund outreach,” she said. “You have to partner.”

People on Medicaid often aren’t getting mail, Howard said, and they “don’t always trust it” when they get it. Having states partner with community organizations, schools, pharmacies and other groups, she said, helps members trust the message.

Texting is also helping states reach members, she said.

Slonaker said texting would be an easy way for Utah to modernize its outreach to Medicaid members.

The state is looking at opportunities for texting, Strohecker said. There’s been an uptick in people opting in to texting, she said, but the state wants to see more and is considering an opt-out program and more descriptive messages for people who receive texts.

Media campaign, automation and other improvements underway

Utah also is working on other improvements, Strohecker said, including automating the ex parte review system. That’s when states attempt to renew coverage by reviewing available data sources to confirm ongoing eligibility, instead of sending out renewal documents and requiring members to respond.

That system has been manual, she said, but the state has implemented the first of three phases to automate the process.

Utah also launched a “broad media campaign” last fall, with materials in 13 languages, Strohecker said, including “targeted messaging to key areas seeing higher rates of disenrollment.”

The state also has officially partnered with the Utah Health Policy Project, through a contract in November, to get more help on the front lines, she said.

Other efforts include a commitment to improve the nearly two-dozen-page application and the development of a one-page form laying out the renewal process, she said.

“It is our desire and intent — and certainly the work that we’re doing and designing — to try to identify areas where there may be problems or gaps, and close those gaps with targeted work,” Strohecker said. “We want members who are eligible to remain eligible.”

Megan Banta is The Salt Lake Tribune’s data enterprise reporter, a philanthropically supported position. The Tribune retains control over all editorial decisions.