Brief What Will Happen to Medicaid Enrollees' Health Coverage after the Public Health Emergency . In the second quarter, that will drop to 5 percentage points. 2716, the Consolidated Appropriations Act (CAA) for Fiscal Year 2023. Filling the need for trusted information on national health issues, Jennifer Tolbert and Healthcare Dive reports that the majority of people with Medicaid do not know that their coverage could end when the public health emergency ends. These plans must describe how the state will prioritize renewals, how long the state plans to take to complete the renewals as well as the processes and strategies the state is considering or has adopted to reduce inappropriate coverage loss during the unwinding period. When the continuous enrollment provision ends and states resume redeterminations and disenrollments, certain individuals will be at increased risk of losing Medicaid coverage or experiencing a gap in coverage due to barriers completing the renewal process, even if they remain eligible for coverage. However, waivers that allowed advanced practice registered nurses (APRNs) to practice at the top of their license will expire on October 9 absent further Congressional action. States can take action to minimize the number of people who become uninsured due to Medicaid eligibility redeterminations after the PHE. Or maybe your circumstances have changed perhaps your income is the same but you have fewer people in your household and your income now puts you at a higher percentage of the poverty level. Now, Democrats are prepared to join them four people close to the negotiations tell POLITICO. The Administration's plan is to end the COVID-19 public health emergency (PHE) on May 11, 2023. But they could choose to do so, and could also choose to waive premiums for CHIP during that time. It can be allowed to expire at the end of the 90-day period or terminated early if deemed appropriate. This policy update will examine several of the health-related COVID-19 Federal Emergency Declarations and which flexibilities will end in May. If the answer is yes, be sure you pay close attention to any requests for additional information from your states Medicaid office, as they may need that in order to keep your coverage in force. The question is: Can they get enough wins to take the political sting off allowing states to kick people off the rolls?. The White House's Department of Health and Human Services (HHS) has extended the COVID-19 state of emergency. Were providing certainty to states and giving them a gradual stream of funding and guardrail requirements that protect people. By law, public health emergencies are declared in 90-day increments. The public health emergency expanded Medicaid coverage eligibility - now that expansion may be going away. That will help us make the concrete plans necessary to make sure this happens in an orderly fashion.. The ARP is still making premiums more affordable. 01:02. The proposed eligibility and enrollment rule aims to smooth transitions between Medicaid and CHIP by requiring the programs to accept eligibility determinations from the other program, to develop procedures for electronically transferring account information, and to provide combined notices. Lastly, states are required to maintain up to date contact information and attempt to contact enrollees prior to disenrollment when mail is returned. Republicans have long demanded an end to the Covid-era Medicaid policy that gives states more funding and bars them from kicking people off the rolls. A majority of states also indicated they were taking steps to update enrollee contact information and were planning to follow up with enrollees before terminating coverage. Some of these waivers had previously expired, but ANA is still advocating to change the law and make them permanently part of the Medicare program. But, when the continuous enrollment provision ends, millions of people could lose coverage that could reverse recent gains in coverage. 10 Things to Know About the Unwinding of the Medicaid Continuous Enrollment Provision, 10 Things to Know About Medicaid Managed Care, FAQs on Health Spending, the Federal Budget, and Budget Enforcement Tools, Health Insurer Financial Performance in 2021. It also provides states more time to prepare for new rules that will put millions in jeopardy of losing their health insurance, something state Medicaid directors have been demanding from legislators. There will also be continued access to pathways for emergency use authorizations (EUAs) for COVID-19 products (tests, vaccines, and treatments) through the Food and Drug Administration (FDA), and major telehealth flexibilities will continue to exist for those participating in Medicare or Medicaid. The recent CIB notes that CMS is expected to issue guidance to address how new reporting requirements (discussed below) may intersect with the requirements described in prior CMS guidance. Its understandable that a primary goal of the redetermination process is to ensure that these individuals transition to other coverage, either from an employer or through the exchange/marketplace. The current PHE ends January 16, 2022, so a 90-day extension takes us to April 16, 2022. This additional match will be slowly wound down through 2023 and the federal match will be returned to what it had been prior to the PHE in January 2024. As part of a Covid-19 relief package passed in March 2020, states were barred from kicking people off Medicaid during the public health emergency in exchange for additional federal matching funds. The Biden administration announced its intention to end the federal public health emergency on May 11, 2023. 3168 0 obj <> endobj We are not ending the PHE, said a Capitol Hill source close to the negotiations, granted anonymity to discuss a deal that is still in flux. Democrats, in contrast, have been hesitant to tie the administrations hands as the virus continues to kill hundreds of people each day and a winter surge of several illnesses strains the countrys medical system. Can I use my Medicaid coverage in any state? Heres what enrollees need to know. The current PHE ends January 16, 2022, so a 90-day extension takes us to April 16, 2022. The main point to keep in mind is that the opportunity to transition to new coverage, from an employer, Medicare, or through the marketplace, is time-limited, although the unwinding SEP described above (announced in late January 2023) gives people significantly more flexibility in terms of being able to enroll in a plan through HealthCare.gov after losing Medicaid during the 16-month window that starts March 31, 2023. Moreover, research shows that when parents gained coverage under the Medicaid expansion, Medicaid participation among their eligible but unenrolled children also increased. including education, public health, justice, environment, equity, and, . But thats no longer relevant in terms of the resumption of Medicaid eligibility redeterminations. The non-partisan Congressional Budget Office assumes the public health emergency for Covid is set to expire in July. 1. prepare for the eventual end of the COVID-19 public health emergency (PHE), including a State Health Official Letter, Promoting Continuity Medicaid eligibility redeterminations will resume in 2023. Under the prior rules, that would have meant that Medicaid eligibility redeterminations (and terminations) could have resumed as of June 2023. endstream endobj startxref Would love your thoughts, please comment. So where does this leave the continuous enrollment requirement? The COVID public health emergency (PHE) is expected to be extended again in January 2023, but the omnibus bill de-links the resumption of Medicaid eligibility redeterminations from the PHE, and allows states to start processing eligibility determinations as of April 1, 2023. After three years of regulatory flexibility in many areas of healthcare delivery, implications of the PHE unwinding for patients, nurses, and communities will be significant. (As well discuss in a moment, the Consolidated Appropriations Act, 2023, has changed this rule). 0 This JAMA Forum discusses the potential ramifications after the COVID-19 public health emergency ends such as limiting telehealth, ending the continuous enrollment requirement in Medicaid, and decreasing regulatory flexibility that has allowed pharmacists to administer COVID-19 vaccines. But we need to leverage every method to reach people on the program.. There is a relatively new special enrollment period that allows people with household income up to 150% of the poverty level to enroll in coverage year-round, for as long as the enhanced subsidies remain in place (so at least through the end of 2025, and possibly longer if Congress grants another extension). The Biden administration on Friday extended the Covid-19 public health emergency for another three months. CLARIFICATION: This report has been updated to clarify that the Congressional Budget Office expects the public health emergency for Covid will expire in July, barring another extension. People who can't access the website or who . But that was an uncertain and ever-changing date, as the PHE has continued to be extended. Contact Us, 2023 Center for Children & Families (CCF) of the Georgetown University Health Policy Institute, McCourt School of Public Policy, Georgetown University | 600 New Jersey Ave. NW | Washington, DC 20001 | 202.784.3138, Georgetown Center for Children and Families Homepage, Percent of Children Covered by Medicaid/CHIP by Congressional District, 2018, Percent of Adults Covered by Medicaid/CHIP by Congressional District, 2018, renewed the COVID-related public health emergency. An Informational Bulletin (CIB) posted on January 5, 2023 included timelines for states to submit a renewal redistribution plan. Another analysis examining a cohort of children newly enrolled in Medicaid in July 2017 found that churn rates more than doubled following annual renewal, signaling that many eligible children lose coverage at renewal. A MACPAC analysis examined coverage transitions for adults and children who were disenrolled from Medicaid or separate CHIP (S-CHIP) and found that very few adults or children transitioned to federal Marketplace coverage, only 21% of children transitioned from Medicaid to S-CHIP, while 47% of children transitioned from S-CHIP to Medicaid (Figure 11). Efforts to conduct outreach, education and provide enrollment assistance can help ensure that those who remain eligible for Medicaid are able to retain coverage and those who are no longer eligible can transition to other sources of coverage. But because Democrats are squeamish about this, theyre going to use it to drive a hard bargain. I was, frankly, a little surprised that Dems were not more willing to cut a deal on this earlier, a health industry lobbyist familiar with negotiations noted to POLITICO. Collectively, these metrics are designed to demonstrate states progress towards restoring timely application processing and initiating and completing renewals of eligibility for all Medicaid and CHIP enrollees and can assist with monitoring the unwinding process to identify problems as they occur. Enrollees may experience short-term changes in income or circumstances that make them temporarily ineligible. %%EOF Theres always a risk of scams and abuses should that happen, Rollins cautioned, arguing that the calling and texting ban should only be lifted for the period of the Medicaid redeterminations. For enrollment reporting, states will provide baseline data at the start of the unwinding period related to applications, enrollment, estimated timeframe for completing initiated renewals, and fair hearings, and then states will submit monthly reports that will be used to monitor these metrics throughout the unwinding period (Figure 10). President Biden says the emergency order will expire May 11. These waivers include strategies allowing states to: renew enrollee coverage based on SNAP and/or TANF eligibility; allow for ex parte renewals of individuals with zero income verified within the past 12 months; allow for renewals of individuals whose assets cannot be verified through the asset verification system (AVS); partner with managed care organizations (MCOs), enrollment brokers, or use the National Change of Address (NCOA) database or US postal service (USPS) returned mail to update enrollee contact information; extend automatic enrollment in MCO plans up to 120 days; and extend the timeframe for fair hearing requests. Democrats want to make that harder, but if they put too many restrictions on states ability to do that, Im not sure how the math would work out. As states prepare to complete redeterminations for all Medicaid enrollees once the continuous enrollment provision ends, many may face significant operational challenges related to staffing shortages and outdated systems. For system readiness reporting, states are required to demonstrate that their eligibility systems for processing renewals are functioning correctly, particularly since states have not been conducting normal renewals while the continuous enrollment provision has been in effect. 2716, the Consolidated Appropriations Act (CAA) for Fiscal Year 2023. However, when states resume Medicaid disenrollments when the continuous enrollment provision ends, these coverage gains could be reversed. CMS has issued specific guidance allowing states to permit MCOs to update enrollee contact information and facilitate continued enrollment. If youre currently enrolled in Medicaid, its a good idea to familiarize yourself with your states eligibility rules, and figure out whether youd be eligible if you were to apply today, with your current circumstances and income. What are your options if youre no longer eligible for Medicaid? So, there is some ambiguity as to when payments will be required to resume. CMS notes in recent guidance that states can increase the share of ex parte renewals they complete without having to follow up with the enrollee by expanding the data sources they use to verify ongoing eligibility. Helping millions of Americans since 1994. Under the ACA, states must seek to complete administrative (or ex parte) renewals by verifying ongoing eligibility through available data sources, such as state wage databases, before sending a renewal form or requesting documentation from an enrollee. A majority of responding MCOs reported that they are sending updated member contact information to their state; nearly all said their state is planning to provide monthly files on members for whom the state is initiating the renewal process and more than half indicated that information would include members who have not submitted renewal forms and are at risk of losing coverage; and more than half of plans reported their state is planning to provide periodic files indicating members whose coverage has been terminated . Twenty-eight states indicated they had settled on plan for prioritizing renewals while 41 said they planning to take 12 months to complete all renewals (the remaining 10 states said they planned to take less than 12 months to complete renewals or they had not yet decided on a timeframe). The PHE has been in place since January 27, 2020, and renewed throughout the pandemic. The lower estimate accounts for factors, such as new people enrolling in the program as well as people disenrolling then re-enrolling in the program within the year, while the higher estimate reflects total disenrollment and does not account for churn or new enrollees. HHS projects that approximately 15 million people will lose eligibility for Medicaid once the normal eligibility redetermination process resumes. While the PHE ends on May 11, in payments rules CMS has extended the waivers for an additional 152 days to allow providers time to undo the waivers. as proposed in the Build Back Better Act (BBB)? These projected coverage losses are consistent with, though a bit lower than, estimates from the Department of Health and Human Services (HHS) suggesting that as many as 15 million people will be disenrolled, including 6.8 million who will likely still be eligible. Read about your data and privacy. Other than that, if you miss the special enrollment period for your particular coverage, youll have to wait until the next annual open enrollment period to sign up for coverage (employers set their own annual enrollment windows; Medicares general enrollment period is January March each year). Similarly, a survey of Marketplace assister programs found that assister programs were planning a variety of outreach efforts, such as public education events and targeted outreach in low-income communities, to raise consumer awareness about the end of the continuous enrollment provision (Figure 9). Findings This cohort study of 4869 Latina patients with gestational (n = 2907) or preexisting diabetes (n . | T p{YWY4,;U|p9 The resumption of eligibility redeterminations is no longer linked to end of public health emergency. The PA MEDI Helpline is available at 1-800-783-7067 from 8 a.m. to 5 p.m. Monday-Friday. 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