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From left, State Medicaid Director Jen Steele and LDH Secretary Rebekah Gee talk about the state's new high-tech enrollment system at the Medicaid enrollment headquarters Wednesday Nov. 28, 2018, in Baton Rouge, La.

Louisiana’s health department has sent nearly 24,000 Medicaid recipients letters warning they will lose coverage if they don’t prove they qualify for the program, marking a full year of a new stricter eligibility system that has caused enrollment to remain consistently lower than before.

After several rounds of wage checks that remove people from the Medicaid rolls unless they prove they don’t make too much money to qualify, the number of people enrolled in Medicaid expansion was 468,414 as of last month. The 23,548 people who received letters this week will have 10 days to reply with more information, and the health department automatically cancels their Medicaid in mid-March if they don’t prove they qualify, a health department spokeswoman said.

Since hitting a peak of about 505,000 enrollees last April, expansion enrollment has stayed consistently lower, hovering between about 465,000 and 468,000.

The state health department has tweaked the new eligibility system since implementing it, in November 2018, as people reported losing coverage despite sending in their renewal paperwork. The system not only checked wages more frequently, but also automatically closed people out of the program if they didn’t get annual renewal paperwork in on time.

The state suspended the auto closures for annual renewals for several months last year before reinstating it for most people.

“We turned on auto closures to full functionality for all populations except those in long-term care,” said Stephen Russo, interim secretary for LDH, in a recent interview.

Recently, LDH began sending out forms that are already mostly filled out for people renewing coverage as a way to make it easier on enrollees to keep their health insurance.

“We’re committed to lifting the barriers to folks out there.”

Rebekah Gee, the health secretary who oversaw the implementation of the new eligibility system and Medicaid expansion under Edwards, stepped down at the start of his second term. Edwards last week said he is hiring Courtney Phillips, currently the head of Texas’ health agency, to lead LDH. Phillips spent several years working for LDH under previous governors Bobby Jindal and Kathleen Blanco.

Gov. John Bel Edwards expanded Medicaid upon taking office in 2016, taking advantage of a key part of the Affordable Care Act in which the federal government pays the vast majority of the costs. Currently, about 90% of the Medicaid expansion program is funded by federal dollars.

According to a recently-adopted Medicaid forecast, spending on Medicaid in Louisiana is expected to continue to rise in the coming years, even as enrollment is projected to fall slightly. Cindy Rives, who oversees LDH’s budget, said the higher costs are driven in part by policy changes, like the Trump administration requiring Medicaid to cover things like Methadone treatment and state lawmakers tweaking the program, among other things.

Rives said the effects of the new eligibility system on enrollment will likely “level off” at some point.

Email Sam Karlin at skarlin@theadvocate.com