By Benjamin Neufeld
The Kaiser Family Foundation estimates that between 5 and 14 million people will lose Medicaid coverage when states “unwind” the continuous enrollment provision this year.
“This unwinding is [going to be] considered the largest health event since the implementation of the [Affordable Care Act],” said Laura Guerra-Cardus at a news briefing held by The Center on Budget and Policy Priorities, in collaboration with Ethnic Media Services (EMS), on Friday, January 27. During the pandemic, the Families First Coronavirus Response Act (FFCRA) required Medicaid programs to keep recipients continuously enrolled and covered until the declared end to the Public Health Emergency. According to KFF.org, Congress passed a spending bill at the end of last year that will put an end to that continuous enrollment provision on March 31. On April 1, states can begin “unwinding” Medicaid coverage by resuming the review process for enrollee eligibility and, “ending coverage for those found ineligible,” according to the EMS news briefing.
As a likely result of the continuous enrollment policy put in place by the Public Health Emergency, Medicaid enrollment grew 30% during the pandemic. Now, 84 million, or 1 in 4, Americans are covered by Medicaid. According to Farah Erzouki, a Senior Policy Analyst at the Center on Budget and Policy Priorities who spoke at the EMS briefing, 18 million people stand to lose Medicaid coverage despite millions of them remaining eligible. People of color and children are particularly at risk.
Laura Guerra-Cardus, the Director of State Medicaid Strategy at the Center on Budget and Policy Priorities, says that those most likely to lose coverage due to ineligibility include young adults who turned 19 during the pandemic and will no longer be eligible for children’s coverage, parents with whose income has risen above the eligibility threshold or who no longer have dependents, and postpartum people past their state Medicaid program’s eligibility period–either 60 days, 6 months, or 12 months after birth depending on the state.
Guerra-Cardus and other experts are concerned that many of these individuals who become ineligible for Medicaid will simultaneously be unable to afford marketplace insurance due to the extremely low income threshold for Medicaid eligibility or ineligibility. She believes states should expand their Medicaid eligibility criteria to account for this potential gap.
Many individuals who lose Medicaid coverage may be eligible for other affordable healthcare options through the Affordable Care Act, but they may have only a limited time to make that transition without experiencing a lapse in coverage.
Many people who are able to retain their Medicaid eligibility may still be at risk of losing coverage due to the logistical challenge state agencies face with processing this unprecedented volume of cases. Strain on these agencies will likely result in mistakes during case processing and inadequate information/outreach to Medicaid enrollees pertaining to the renewal process. Due to the Public Health Emergency policy, most, if not all of these enrollees, have likely not been in contact with their Medicaid agencies in at least three years. Farah Erzouki worries that unfamiliarity with the renewal process could result in mistakes on behalf of enrollees and a potential lapse in coverage. Additionally, she suspects that many enrollees have changed addresses during the pandemic and therefore will not receive their renewal notices/information in the mail.
“This really is an all hands on deck situation,” said Kristen Golden Testa, the Health Policy Director for The Children’s Partnership. Testa, along with Erzouki and other experts, are encouraging everyone–particularly Medicaid agencies, Medicaid enrollees, community organizations, and media outlets–to prepare for this unwinding process. They want to see a stronger informational campaign around the unwinding, including resources and instructions for those who will be affected. Erzouki also believes Medicaid agencies should act now to lessen the burden of this crisis by expanding eligibility requirements, making the renewal process simpler, automating renewals for certain categories of enrollees so that not all 84 million people need to be contacted individually, implementing online/over-the-phone renewals, expanding contact methods for enrollees to text and email rather than just mail, and initiating hiring incentives to address Medicaid agency staffing shortages prior to beginning the unwinding process.
Those currently on Medicaid should make sure their Medicaid agency has their correct address on file and be on the lookout for their renewal form which should arrive between April 2023 and April 2024. They should also familiarize themselves with their program’s eligibility requirements and begin proactively looking for other coverage options through the Affordable Care Act marketplace by visiting healthcare.gov if they suspect they will lose eligibility.
Benjamin Neufeld is an Independent Reporter for The Weekly Issue/El Semanario.
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