While states are terminating beneficiary enrollment due to the end of public health due to Covid-19 … [+]
Since April 1stAbout 1.5 million people have been cut from Medicaid coverage as states halted enrolling beneficiaries following the end of the Covid-19 public health emergency. According to the Kaiser Family Foundation (KFF), an impartial health policy organization.
Florida leads the pack with the highest unenrollment rate, which it has already done several hundred thousand people away of the Medicaid rolls. Of those whose cases were decided in May, more than 50% were deregistered in Arkansas, Idaho, Kansas, Nevada, New Hampshire, Oklahoma, South Dakota, Utah and West Virginia.
There’s a backstory to this significant disruption to Medicaid, and it has to do with something that happened six months ago in Congress. Last December, Congressional leaders reached a major deal in the field of health policy. The omnibus bill included a number of health care provisions, including a relaxation of Medicare salaries for physicians, modest investments in future pandemic preparedness, and major changes to Medicaid enrollment policies.
The legislation paved the way for Medicaid state agencies to restart the “eligibility reassessment” after a three-year hiatus due to the Covid-19 pandemic. At the start of the 2020 Covid-19 pandemic, the legislative and executive branches of government recognized that a health crisis of this magnitude would be a particularly bad time for people to be without access to health care. That’s why they demanded it states keep people on Medicaid as long as the nation was officially in a public health emergency. Formally, the policy was known as “continuous enrollment,” and it included granting federal funds to states to expand Medicaid enrollment.
According to the latest available data released in February this year, more than 93 million people nationwide were enrolled in Medicaid. Between March 2020 and April 2023, there was an increase of more than 23 million Medicaid beneficiaries. The number increased as federal law barred states from deregistering people from Medicaid while the Covid-19 public health emergency was in effect.
But the omnibus law that took effect last December stipulated that states could kick beneficiaries off the Medicaid rolls starting April 1.stand then run controls on Medicaid enrollees to ensure they are eligible for the program. That redeployments have resumed, states are looking at the backlog of cases going back to 2020 to determine if people are still eligible for Medicaid. States have one year to complete the process.
The people most affected by this eligibility reassessment process are those who applied for Medicaid coverage during the Covid-19 pandemic. Many subscribers can now have income too high to qualify for Medicaid and yet they can’t quickly (or at all) switch to an alternative coverage offered by the insurance exchanges or Affordable Care Act employers. Many others may continue to meet the eligibility criteria for Medicaid but lose coverage because they fail to meet the onerous administrative hurdles. The eligibility redeterminations are cumbersome to navigate for enrollees who get dropped off but then want to re-enroll. The problem is compounded by the fact that some states seem to be making signing up for and re-enrolling in Medicaid quite difficult.
Vulnerable people, such as children, are particularly susceptible to falling between two stools. As an illustration, under the provisions included in the omnibus law passed last December, states must be “ongoing eligibility” for children in both Medicaid and the Children’s Health Insurance Program. Nevertheless, while this emergencies exist in theory for children, proponents fear that in practice many households that lose coverage contain children who actually still qualify. Indeed, a report released last year by the U.S. Department of Health and Human Services predicted that more than 50% of children who claim to be unenrolled are in fact eligible for Medicaid.
Admittedly, it’s no easy task for states to track down enrollees and guide them on their possible path back to recovery as Medicaid beneficiaries. Efforts by state Medicaid agencies to provide outreach, education, and enrollment assistance can ensure that those who remain eligible for Medicaid can maintain coverage, while those who no longer qualify can transition to other sources of coverage.
Some beneficiaries who are deregistered may receive coverage through their employer. Nevertheless, many employers do not provide health care benefits, particularly in the food, hospitality and unskilled service industries. Others will try to get affordable coverage in the individual market through state-created exchanges. But for many people, this can also be a bureaucratic challenge.
The Centers for Medicare and Medicaid Services (CMS) has offered states guidelines and even imposed certain requirements. For example CMS required states to submit “renewal redistribution plansdescribing how the state will prioritize re-enrollments, 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 mitigate “improper loss of coverage” during the settlement period. States were told to submit their plans to CMS by February 15, 2023. 20 states had not posted their renewal redistribution plan.
Going forward, how states handle the resolution process will have important implications for the ability of eligible persons to maintain or renew coverage. Here states may have been given too much leeway. Evidence from the first few months of re-determinations indicates that approaches to enrollee resolution vary wildly from state to state.
And if the recent past is any indication, the elimination of Medicaid coverage will negatively impact people’s health insurance status. In a study conducted by KFF spanning the period 2016-2019, researchers found that during the year following Medicaid deregistration, two-thirds of people were uninsured at a given moment.
The expansion of Medicaid during the Covid-19 pandemic helped stabilize the situation for these people and many others. The proportion of people without health insurance even fell to 8.6% by 2021a historic low.
However, as states now pursue Medicaid deregistration, coverage gains are likely to be reversed. The Congressional Budget Office projects that 6.2 million people who unenroll from Medicaid in the next 18 months will become uninsured. This is obviously not a desirable policy outcome.
So while expanding continuous enrollment in Medicaid would cost states money, the alternative, a larger uninsured and uninsured population, is also costly to healthcare systems, patients and society as a whole. Many people will find it very difficult to obtain coverage through their employer or in any other way. Without coverage, many may delay needed care, and some who fall ill may end up putting additional strain on already overburdened emergency services.
As with any policy calculation, it is advisable to consider the opportunity cost, that is, assess what is being given up in terms of costs and benefits when making a consequential decision. Otherwise, a penny-wise, pound-foolish policy may follow: save money in the short term, but exacerbate the already dire situation many Americans find themselves in with regard to health care coverage, which in turn leads to increased costs for the health care system. healthcare system.
Rarely are debates in Washington DC or in state capitals conducted on an opportunity cost basis. But when considering a policy as far-reaching as eliminating continuous enrollment in Medicaid, it seems prudent to weigh the costs of missed alternatives.