Maryland officials are poised to again review their Medicaid rolls for those who no longer qualify.
The state ceased such reviews for six months as it worked to open the new online marketplace for people to buy public and private insurance plans and adjust to new rules. The absence of such reviews was estimated to cost taxpayers up to $30 million, though officials believe the amount will be lower.
"There will be some kind of analysis," said Dr. Joshua Sharfstein, state health secretary. "But it could take a few months."
There are more than a million people on Medicaid in Maryland, more than 300,300 added as the state expanded its program under the federal Affordable Care Act. Eligibility is determined annually.
Normally, thousands of people "churn" out of the program each year as their incomes rise — 20 percent joined and 14 percent lost eligibility in 2011, for example, according to a study by the Hilltop Institute, a health research organization at the University of Maryland, Baltimore County.
But more people are expected to remain in the program now because the threshold was bumped from close to 100 percent of the federal poverty level to 138 percent, or almost $33,000 for a family of four, as part of the state's expansion of Medicaid.
Federal funds are largely paying for the increased cost associated with the expansion.
About two-thirds of the states stopped doing Medicaid eligibility reviews during the rollout of the health insurance exchanges.
State officials will continue to use part of their current, antiquated system to review Medicaid recipients' eligibility as they build a new website that can accommodate enrollment in private insurance plans and Medicaid.
Sharfstein said Medicaid recipients won't be able to renew applications on the new website until 2015. But he expects new recipients will be able to enroll this fall. Those signing up for private plans are expected to use the new website in November, during open enrollment.
Eventually, those who lose Medicaid coverage will be able to immediately shop for a private plan on the same site. That should lessen the gaps in coverage some on Medicaid now experience, Sharfstein said.
Researchers have found that churn from the program causes inconsistencies in care and added administrative costs.
And since every state has had to build or join an exchange, and a quarter of states have expanded their Medicaid programs, the focus is now on how those renewals are going.
One state initially having trouble was Washington, which adopted new income thresholds early to avoid big delays in renewing Medicaid plans, according to researchers at the Center for Children and Families at Georgetown University's Health Policy Institute. But consumers had trouble with the new, unfamiliar system.
Renewals are bound to be more complicated elsewhere because of confused consumers, said Tricia Brooks, a senior fellow at the Center for Children and Families. "Certainly with this massive of a transformation, there will be hiccups."