Regular Medicaid coverage redeterminations will likely resume in 2022, so providers may see many patients lose or change coverage.
While this could lead to uncertainty for providers and patients, healthcare entities can help connect patients with resources and guide them into alternate coverage and minimize disruptions in their care.
The Urban Institute estimates roughly 15 million people will be kicked off Medicaid when redeterminations start back up, after Medicaid enrollment has reached record highs during the COVID-19 pandemic. States paused redeterminations in order to receive enhanced federal Medicaid funds during the ongoing public health emergency. That emergency status is likely to be renewed as the pandemic continues, but redeterminations could resume next year if Congress passes the Build Back Better Act. The domestic policy legislation includes a provision allowing states to review their Medicaid rolls as soon as April even if a public health emergency declaration is in force.
"It's an important collaborative opportunity across the healthcare sector that will require the actions of the federal government, the states, health plans (and) healthcare providers to ensure that this can really be carried out in the most thoughtful and supportive way," said Alice Lam, a managing director at Manatt Health.
Policymakers are focused on how redeterminations will affect beneficiaries, but providers may face challenges, too, said National Association of Medicaid Directors Executive Director Matt Salo.
Fewer people with health coverage means more less utilization and more unpaid medical bills. The impact on provider reimbursement depends on how many people kicked off Medicaid actually find another source of coverage. About one-third of adults in this group should qualify for subsidized insurance from the health insurance exchanges, and many more will have access to employer-sponsored coverage, the Urban Institute predicts. And in some cases, exchange plans pay providers more than Medicaid, said Jennifer Tolbert, director of state health reform at the Kaiser Family Foundation.
But many Medicaid-eligible people are likely to lose benefits because of procedural issues even if they still qualify based on income, and not everyone who could get exchange subsidies will enroll in a plan. "We're kind of considering it a little bit of a Medicaid cliff," said Shyloe Jones, senior manager of health equity at Families USA.
More people may go without insurance overall, stretching community health center budgets and raising healthcare costs across the board, said Jeremy Crandall, director of state affairs for the National Association of Community Health Centers. "The fewer options for coverage that our patients have, the more of a strain it puts on our health centers to be able to provide the care that's critical to our patients," he said.
Providers can mitigate this by connecting patients with resources to navigate redeterminations or exchange enrollment, said Tricia Brooks, a professor at Georgetown University's Center for Children and Families.
Many hospitals and community health centers have staff members dedicated to helping with insurance enrollment, but providers at individual practices can guide their patients through what to expect, too. Medical offices could set up phones where people can call Medicaid directly to update their information or mail in batches of enrollment forms on behalf of patients, Brooks said.
The Centers for Medicare and Medicaid Services can also simplify the process for providers and patients by allowing providers to update beneficiary contact information based on verbal attestations from patients, she said.
Providers have a financial incentive to ensure patients have coverage, Brooks said. Although assisting patients who need coverage can add to administrative burden and costs, so would losing a large share of patients if they become uninsured. States could support these efforts using funding from the American Rescue Plan Act, she said.
In the aftermath of redeterminations, providers may encounter patients who don't know their Medicaid benefits have lapsed. Providers will hear stories about patients' experiences with the redetermination process, and they can help policymakers improve the system by collecting and reporting that feedback, Brooks said.
President Joe Biden's administration will allow states one year after the end of the public health emergency to resume regular redeterminations. However, some states have laws requiring redeterminations to be conducted sooner.
Not all coverage is equal, but getting people into some sort of insurance would soften the impact of people losing Medicaid, said Jerry Vitti, CEO of Healthcare Financial, which contracts with providers to assist patients enrolling in benefit programs. "If we can improve coverage retention by putting folks through different doors, I think that's a mitigating factor," he said.