More than 12 million people have enrolled in Medicaid and the Children's Health Insurance Program since COVID-19 outbreaks began in the U.S., largely due to shifting eligibility requirements and increases in federal funding to make care more accessible.
Now, community health centers are worried these flexibilities might not last once the public health emergency ends, leaving many without insurance.
Ninety percent of health centers believe the termination of pandemic-related Medicaid policies will lead to patients losing their benefits, forgoing vital healthcare services and relying on emergency and urgent care departments for treatment, according to a 2021 survey of federally-qualified health centers by the National Association of Community Health Centers.
A lack of Medicaid flexibilities may mean health centers will not be able to continue their current services and methods of care delivery, said Jeremy Crandall, director of federal and state policy at NACHC.
"When children and adults have more access to preventive care, it prevents worsening conditions down the line," Crandall said.
States began receiving a 6.2% hike in their Federal Medicaid Assistance Percentage as part of the Families First Coronavirus Response Act which passed in March 2020, and they were prohibited from disenrolling members from Medicaid during the public health emergency.
This ultimately contributed to Medicaid and CHIP enrollment increasing by 17.1%, according to data from the Center for Medicare and Medicaid Services.
Prior to the pandemic, 48% of health center patients were Medicaid and CHIP beneficiaries, Crandall said, and most health centers reported up to a 25% increase in Medicaid patients over the course of the pandemic.
Nationwide, a total of 1,400 community-directed provider clinics serve nearly 29 million people, including one in five Medicaid beneficiaries and one in three people living in poverty.
Enrollment protections have allowed more working families, vulnerable populations and patients with chronic conditions to experience primary and preventive care at lower costs, said Sarah Baizer, director of research policy at NACHC.
In selecting the pandemic-era Medicaid policies that would impact patients the most if they ended, 96% of NACHC survey respondents chose telehealth flexibilities, 72% listed allowing federally qualified health centers to bill Prospective Payment Systems for additional services provided, and 52% said continued interest in the federal Medicaid matching rate.
To protect underserved patients after the pandemic ends, NACHC is recommending that Congress extend key Affordable Care Act marketplace subsidies and enrollment periods to limit cost-sharing, reduce premiums, and provide pathways to coverage for low income people, while also investing in outreach, enrollment, and navigators for people in the Medicaid coverage gap, Baizer said.
Other areas currently under consideration by Congress include: providing more information to states about the planned phase-down of their Federal Medicaid Assistance Percentage increase; extending the timeframe for states to complete pending eligibility and enrollment actions; requiring states to complete an additional redetermination for those deemed ineligible for Medicaid; and ensuring state-authorized Medicaid audio-only telehealth services for the elderly, homebound and rural residents can continue beyond the public health emergency.
If any of these protections are eliminated, health centers said it could lead to more uninsured patients, life-threatening situations for those unable to access treatment, a sliding fee scale for care, and a decrease in COVID-19 testing and vaccination.
"Almost all health centers through the Medicaid flexibilities were able to provide more services to patients who would otherwise go without care," Baizer said. "Patients who, in absence of these flexibilities, would likely seek care in an emergency department."
