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Continuous Coverage Unwind Reports

Public Health Emergency Planning

Monthly Reports

Understanding the Data and Federal Reporting Requirements

Understanding the Data

The monthly report with data on the unwind of the continuous coverage requirement for Colorado has been submitted to CMS and is available on the PHE Unwind Reports page. This page will be updated regularly after data is submitted to the federal government.  

Members of the media, legislators and others can reference these monthly metrics with important context of what they mean to ensure consistent and accurate information is available to the public. HCPF will not be providing “ad hoc” metrics between reporting periods. 

The information below provides critical context for understanding continuous coverage unwind data; it includes:

  1. Key terminology
  2. Baseline data on Health First Colorado and Child Health Plan Plus (CHP+) coverage before the continuous coverage unwind began;
  3. Renewal process timeline;
  4. Understanding federal unwind reporting elements; and
  5. Frequently asked questions about renewal data.
 

Key Terminology

There are a few key terms that are helpful to understand the renewal process and reporting.

  1. Renewal packet - Prepopulated forms sent to a member to see if anything has changed and request necessary verification to determine whether a member continues to be eligible to receive Health First Colorado or Child Health Plan Plus (CHP+) health coverage. Also referred to as a redetermination or RRR.
     
  2. Modified Adjusted Gross Income (MAGI) - Modified Adjusted Gross Income refers to the methodology by which income and household composition are determined for the MAGI Medical Assistance groups under the Affordable Care Act. These MAGI groups include Parents and Caretaker Relatives, Pregnant Women, Children, and Adults.
     
  3. Non-MAGI - Low-income individuals may qualify for medical assistance if they do not meet the MAGI criteria above, but do meet one of these criteria: age 65+, blind, individuals with disabilities by Social Security Administration standards. This group is referred to as “Non-MAGI.”
     
  4. PEAK - an online portal where Coloradans can apply for and manage several benefits including food assistance, cash assistance, transportation, and health care.
     
  5. Procedural denial - This definition varies by state due to differing eligibility processes. In Colorado, this refers to the number of Health First Colorado or CHP+ members who were found to be no longer eligible for coverage in the reporting month for reasons such as: 1. did not respond to the renewal packet/failure to complete the renewal process, 2. failed to provide verification, 3. did not sign their renewal packet, 4. whereabouts are unknown.
     
  6. Ex Parte - “Ex parte” refers to a process that states use to automatically renew members based on recent information already on file. This information is reported by members and/or available from other data sources.
     
  7. Pending application - an application that has been submitted but has not yet been fully processed.
 
 

Colorado’s Medicaid Population Before Continuous Coverage Ended

Source: Annualized data from the last full fiscal year before continuous coverage unwind began, July 2021-June 2022.

 

Renewal Process Timeline

Bar chart displaying renewals due by month from May 2023 through April 2024 showing Sept through December of 2023 with the highest ranging from 90,951 to 99,898 households and May 2023 with the lowest at 69,164 households.

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Note: These numbers are by household. More than one member can make up a household. Individual reports will indicate if the information is by household or by individual. Most reporting is at the individual level.

Each state can take a different approach to unwinding the continuous coverage requirement. Colorado has chosen to take the full 12 months (14 months including noticing) to complete the unwind of the continuous coverage requirement to align with a member’s existing renewal month.  For details on how the renewal process in Colorado works, including overviews, sample notices and videos visit the PHE Planning Resource Center. Members' frequently asked questions about the process are available at healthfirstcolorado.com/renewals.

Understanding Federal Reporting Requirements

Federal Reporting Elements Overview

All states will be required to report the following data elements to the federal government as part of qualifying for enhanced federal matching funds during the unwind period as outlined in the Consolidated Appropriations Act.

 

Reporting ElementDefinition for Colorado
Total number of Medicaid and CHIP beneficiaries for whom a renewal was initiated.In Colorado, this is Health First Colorado and CHP+ members whose renewal process started in the reporting month.  Colorado sends notices 60-70 days in advance of renewals being due. So members with renewals due in May began receiving notices in March.
Total number of Medicaid and CHIP beneficiaries for whom Medicaid and CHIP coverage was renewed.In Colorado, this is Health First Colorado and CHP+ members who were renewed in the reporting month, including ex parte, paper, and PEAK renewals.
Of the Medicaid and CHIP beneficiaries whose Medicaid and CHIP coverage was renewed, those who were renewed on an ex parte basis. Colorado uses data from SNAP and other sources to help auto renew members through the ex parte process (defined above in Key Terms). Members who are automatically renewed do NOT need to take action to keep their coverage and will receive a “Notice of Action” letter showing they are approved for coverage. Members may also receive a letter after they are renewed asking if their income information is correct. They must respond to this letter to continue qualifying for coverage. Ex parte is done at the state level, not at a county level. Ex parte rates are available statewide only.
Total number of individuals whose coverage for Medicaid or CHIP was terminated. In Colorado, this refers to the number of Health First Colorado or CHP+ members who were found to be no longer eligible for coverage in the reporting month.
Total number of individuals whose coverage for Medicaid and CHIP was terminated for procedural reasons. In Colorado, this refers to the number of Health First Colorado or CHP+ members who were found to be no longer eligible for coverage in the reporting month for reasons such as: 1. did not respond to the renewal packet/failure to complete the renewal process, 2. failed to provide verification, 3. did not sign their renewal packet, 4. whereabouts are unknown.  HCPF’s communications and outreach with health plan and other partners focuses on reminding individuals they need to take action when their renewals are due to ensure members keep their coverage if they are eligible. Messaging was added to the renewal envelopes - URGENT - PLEASE REPLY - to further emphasize the need to take action. Public Service Announcements, posters, toolkit materials and earned media will help raise awareness. Partner efforts to encourage members to update their contact information are also designed to mitigate procedural denials.
Total number of beneficiaries who were enrolled in a separate CHIP.In Colorado, this refers to the number of Health First Colorado members who were up for renewal that qualified and were enrolled in CHP+ coverage in the reporting month.
For each state call center, total call volume for the reporting month.From the Medicaid Customer Contact Center (MCC), this refers to the total call volume for the reporting month.
For each state call center, average wait times.This refers to the average time a caller waits before the call is answered.  Colorado will be reporting metrics from our Medicaid Customer Contact Center (MCC).
For each state call center, average abandonment rate.This refers to the rate of callers to call centers that drop off before the call is answered. Colorado will be reporting metrics from our Medicaid Customer Contact Center (MCC).

Monthly Unwinding Data Report

The below chart outlines monthly federal reporting elements on the Centers for Medicare and Medicaid Services (CMS) Unwinding Data Report and a description of what those data elements mean.

Reporting ElementDefinition for Colorado
Application Processing

 

1. Total pending applications received between March 1, 2020 and the end of the month prior to the state's unwinding period

 

This is the number of applications for coverage received between March 1, 2020 and February 28,2023 that had not been fully processed (referred to as “pending”) before the beginning of the unwind of the continuous coverage requirement.  In Colorado, Medical Assistance sites and county partners process the applications for Health First Colorado and CHP+ coverage. Federal regulations allow for up to 45 days to process a new application (90 days if a disability determination is required).   

 

1a. Of the pending applications: Total MAGI and other non-disability applications

 

Number of pending applications that do not require a disability determination.  

 

1b. Of the pending applications: Total disability-related applications 

 

Number of pending applications for disability related programs

 

2. Of those applications included in Monthly Metric 1, the total number of applications completed as of the last day of the reporting period (2a+2b)

 

Total pending applications completed in the reporting period

 

2a. Completed MAGI and other non-disability related applications as of the last day of the reporting period

 

Total pending applications completed for programs that do not require a disability determination as of the last day of the reporting period.

2b. Completed disability-related applications as of the last day of the reporting period

 

Total pending applications completed  for disability related programs as of the last day of the reporting period.

 

3. Of those applications included in Monthly Metric 1, the total number of applications that remain pending as of the last day of the reporting period (3a+3b)

 

Total pending applications left to process

 

3a. Pending MAGI and other non-disability applications as of the last day of the reporting period

 

Total remaining pending applications for non-disability programs as of the last day of the reporting period.

 

3b. Pending disability-related applications as of the last day of the reporting period

 

Total remaining pending applications for disability related programs as of the last day of the reporting period.

Renewals Initiated
4. Total beneficiaries for whom a renewal was initiated in the reporting periodMembers whose renewals were started in the reporting period.   Colorado initiates (starts) the renewal process approximately 75 days in advance of the renewal due month. This includes starting the ex-parte process and sending out approvals if determined eligible through ex parte. If not determined eligible through ex parte, 60-70 days in advance of the renewal date, notice is provided for renewals. For example, ex parte and  notices were sent in March for renewals due in May.
Renewals and Outcomes

5. Total beneficiaries due for renewal in the reporting period

 

Members whose renewal is due in the reporting period

 

5a. Of the beneficiaries included in Metric 5, the number renewed and retained in Medicaid or CHIP (those who remained enrolled) [5a(1)+5a(2)]

 

Members who were up for renewal in the reporting period that stayed enrolled.

 

5a(1). Number of beneficiaries renewed on an ex parte basis

 

Members who were automatically renewed in the reporting period and remained eligible for coverage in the reporting period.  

 

5a(2). Number of beneficiaries renewed using a pre-populated renewal form 

 

Members who completed the renewal process by returning the renewal packet and requested information and remained eligible for coverage in the reporting period.

 

5b. Of the beneficiaries included in Metric 5, the number determined ineligible for Medicaid or CHIP (and transferred to Marketplace)

 

Members who were determined ineligible for reasons such as being over the income limit, moved out of state, moved to Medicare, or passed away. Those who no longer qualify for Health First Colorado or CHP+ and who could transition to marketplace coverage are referred to Connect for Health Colorado in the reporting period.

 

5c. Of the beneficiaries included in Metric 5, the number terminated for procedural reasons (i.e. failure to respond) 

 

Members who were terminated because we were unable to make an eligibility determination. The most common reasons include: did not respond to the renewal packet/failure to complete the renewal process, failed to provide verification, did not sign their renewal packet, or whereabouts are unknown.

 

5d. Of the beneficiaries included in Metric 5, the number whose renewal was not completed

 

Members whose renewals within the reporting month are still pending completion. This could be due to a request for additional information or the worker is still processing the returned renewal packet.

 

6. Month in which renewals due in the reporting month were initiated

 

Colorado initiates (starts) the renewal process approximately 75 days in advance of the renewal due month.(i.e. May renewals were initiated in March)

 

7. Number of beneficiaries due for a renewal since the beginning of the state's unwinding period whose renewal has not yet been completed

 

Total number of members with renewals due that have not been completed (pending renewals). In Colorado, counties and MA sites are required to process pending renewals within federal guidelines.  Once renewals are processed, members find out if they still qualify. If they no longer qualify they receive information about Connect for Health Colorado's health insurance marketplace.

Fair Hearings

8. Total number of Medicaid fair hearings pending more than 90 days at the end of the reporting period 

Members have a right to appeal eligibility decisions, appeal rights are included in official notices. This metric tracks appeals that are pending more than 90 days.

Bar chart of average renewals showing Pre Pandemic averages for Calendar Year (CY) 2018/19 57% remain covered, 41% losing coverage, 29% Eligibility denials and 12% procedural denials; PHE Unwind averages May 2023-April 2024 show 55% remain covered, 43% losing coverage, 19% Eligibility denials and 24% procedural denials; and Post PHE Unwind averages May-October 2024 show 79% remain covered, 17% losing coverage, 8% Eligibility denials and 9% procedural denials.

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* May 2024-October 2024 numbers reflect the most recent data including changes during the reconsideration periods.