November 14, 2022
© 2022 – Don Gerdts. All rights reserved.

Background

Over 85 million Americans (about 1/4 of the US population) currently receive benefits from Medicaid and the Children’s Health Insurance Program (CHIP), the publicly funded health insurance programs for low-income children and qualifying adults.

During the pandemic, Congress passed The Families First Coronavirus Response Act, which made more federal funds available to states if they agreed to keep people on the Medicaid rolls until the public health emergency ended. The law granted a reprieve from the re-enrollment rules that require Medicaid beneficiaries to prove eligibility at least every 12 months.

As a result, enrollment in Medicaid and the Children’s Health Insurance Program (CHIP) has increased over 19 percent since the pandemic began. However, the Families First Coronavirus Response Act specifies that Medicaid beneficiaries must re-determine their eligibility once the federal public health emergency is declared to have ended.

The Kaiser Family Foundation projects up to 15 million people will lose eligibility for Medicaid coverage when going through the required re-determination.

Good News and Bad News

The good news is that the loss of Medicaid coverage qualifies people to enroll in the federal marketplace for 2023 coverage past the Jan. 15 deadline.

The bad news in this situation is that most Medicaid recipients are unaware that states will redetermine their eligibility for the program when the COVID-19 public health emergency ends, and fewer than one third know what other coverage options exist, according to an Urban Institute policy brief.

As a result, HHS projects that nearly five million Medicaid beneficiaries will lose coverage altogether due to administrative churn and inability to navigate the system. However, while everyone who loses their Medicaid coverage will qualify for coverage in the federal ACA marketplace, many more will forego coverage for financial reasons.

Why? Per HHS, less than a third of those projected to lose eligibility could qualify for marketplace premium tax credits, resulting in a new financial burden that many families will determine they cannot prioritize.

Conclusion

Nearly 80% of respondents surveyed by the Urban Institute said they weren’t told how to navigate the process. In fact, more than 60% had heard “nothing at all” about the Medicaid re-determinations.

In my opinion, the onus is on state Medicaid agencies to increase outreach and simplify renewal processes to minimize unnecessary coverage losses.

Next Steps

We’d love to hear your thoughts on this topic!  Will the end of the COVID-19 public health emergency create another public health crisis, or are the challenges with the imminent changes to Medicaid coverage “much ado about nothing”.

TripleAim Strategy Advisors can help stakeholders in the healthcare ecosystem by providing insights and develop and implement strategies to advance equitable, value-based care.

Contact us to discuss this important topic or see additional ways we can help!