About halfway into a yearlong effort to renew health insurance for the 1.8 million Marylanders on Medicaid, 100,000 people have now lost their coverage — not because they didn’t qualify, but because they did not turn in the necessary paperwork.

In November, more than 1 in 5 people up for renewal, or about 34,000, lost their coverage from the state-administered public health insurance program, for so-called “procedural” reasons. That’s the most in a single month since the COVID-19 public health emergency ended and Maryland resumed updating Medicaid rolls in May.

November also marked the end of a three-month pause in coverage terminations while health officials fixed an error that caused up to 3,100 Maryland children to be wrongly dropped; the kids’ coverage was reactivated while the state reviewed their eligibility. People who didn’t get their renewal paperwork in on time started losing coverage again last month. More will follow in December.

As things stand now, Maryland is doing better than most states at minimizing paperwork-related coverage losses — 11% of the 906,000 people up for renewal since April, when the state began to send out notices, have lost coverage for procedural reasons. Texas had the most, according to health policy research institute KFF, at 62%.

The number of people losing coverage in Maryland, though, is still outpacing an early estimate. Officials at the Maryland Health Benefits Exchange previously predicted that 80,000 Marylanders could lose Medicaid benefits over the course of the year, and that number has now been surpassed six months in.

Maryland Department of Health officials have been reticent to set numeric estimates or goals for the unprecedented effort.

“We do not have estimates for the remainder of the redetermination period,” said Chase Cook, acting communications director of the department. “Our goal is to stay focused on ensuring that everyone who is eligible for Medicaid remains covered by continuing comprehensive communication campaigns and a host of federal flexibilities and authorities. Our goal always is to ensure that we have as low of a procedural termination rate as possible.”

The state sends out renewal notices to a different group of beneficiaries each month on a rolling basis. About 652,000 Marylanders have successfully renewed coverage since the process started.

An additional 74,000 people have lost coverage in Maryland because they were no longer eligible, likely because they now earn too much to qualify. These beneficiaries are referred to the state health exchange to obtain coverage.

Some groups have lost coverage for procedural reasons at higher rates than others. Ryan Moran, deputy secretary for health care financing and Medicaid director for the Department of Health, said at a State House briefing last week that losses have been greater in Western Maryland and some areas in Montgomery and Prince George’s counties, particularly among adults between 21 and 44 years old. That’s prompted more advertising and outreach in those areas.

Black beneficiaries, children and residents of Baltimore City have retained coverage at higher rates, Moran said.

Many people on Medicaid, who are low-income and more likely to be unstably housed, may have moved or changed contact information in the three years since renewals were last required. The state launched a “check-in” campaign and website in the spring to encourage people to update their contact information.

While Maryland has secured several federal waivers that allow some shortcuts to the renewal process, it has elected not to join more than 30 other states that can use the United States Postal Service change-of-address database or the Medicaid-managed care organizations to help update contact information.

People who lose their Medicaid coverage for procedural reasons have 120 days to get it reinstated if they turn in their paperwork.