States need more time to restart Medicaid eligibility redeterminations to prevent further disruptions to healthcare coverage and their budgets, experts said during a Medicaid and CHIP Payment and Accession Commission meeting Thursday.
When Congress passed the Families First Coronavirus Response Act in March, it required states to give continuous Medicaid coverage to enrollees during the pandemic to receive a 6.2% boost in federal Medicaid funding. The move effectively barred states from disenrolling people from their Medicaid programs until the COVID-19 public health emergency ends, causing the program's rolls to grow.
The stipulation creates budgetary uncertainty for states because they don't know when the public health emergency and, in turn, their increased federal matching funds will stop.
"It's very different than what we've seen in past downturns," said MACPAC Commissioner Darin Gordon, a consultant and former director of Tennessee's Medicaid program.
Now experts worry states won't be able to handle the backlog of redeterminations, which need to start the same month the public health emergency ends. But officials said the timeline isn't realistic because states don't have the resources to complete the process for new and existing beneficiaries so quickly. The pandemic has created massive downward pressure on state budgets thanks to declining revenues and increasing costs, causing them to slash expenses.
"We're cutting administrative costs right now … I can't imagine where we would get more staff," said Lee Guice, director of policy and operations for Kentucky's Medicaid program.
That could put states at risk for millions of dollars in CMS clawbacks for improper Medicaid payments if they don't have the staff to vet growing numbers of Medicaid enrollees.
"You have to have somebody look at the document to make sure it's not a picture of a cat," Guice said.
State officials want CMS to issue guidance on handling redeterminations three to six months before the public health emergency ends. That's because they have to coordinate several sunset dates for state flexibilities created by federal legislation, said René Mollow, deputy director for healthcare benefits and eligibility for the California Department of Health Care Services. CMS should work with states to develop the guidance since state redetermination processes vary considerably, she said.
Jennifer Wagner, director of Medicaid eligibility and enrollment for the Center on Budget and Policy Priorities, said CMS should give states 12 months to get up-to-date on redeterminations since enrollment will remain high after the pandemic ends. Guice, Mollow and several MACPAC commissioners supported the idea but said it would still be hard for states to follow the rules unless Congress extends the enhanced Federal Medical Assistance Percentage.