From the use of telehealth to predictive analytics, healthcare leaders are engaged in a national conversation about how to build on what's working during the COVID-19 pandemic.
Medicaid belongs high on this list. One bold measure Congress enacted—providing continuous Medicaid coverage to enrollees—should not end with the pandemic.
Since the pandemic's outbreak, more than 41 million Americans have lost their jobs, and according to one estimate, more than 27 million of them risk losing the private health insurance attached to their jobs, depending on the economy. Millions of them are turning to Medicaid to maintain access to care.
In normal times, Medicaid is characterized by churn. While millions of people enroll in Medicaid every year, millions are also dropped from the program because of complex enrollment rules, only to then turn around and reapply. These interruptions are caused by factors including minor fluctuations in income, moving to another area, failure to submit periodic reports, or being unable to renew enrollment on a timely basis. This frustrates and confuses both patients and healthcare providers and can compromise both access to and quality of care.
Congress recognized the need for continuous coverage in the Families First Coronavirus Response Act. The law, enacted in mid-March, required states to provide continuous Medicaid coverage to enrollees during the pandemic as a condition of receiving a 6.2% bump in federal support.
But there's a catch. Continuous coverage will end when the government declares the pandemic over, even though the need for it will not. Indeed, because many people are still afraid to go to clinics or hospitals now, they are delaying even essential care, from vaccinations to chronic-care management to needed surgery. This pent-up demand will explode as the healthcare environment stabilizes. Cutting off Medicaid coverage to people who need it—and will continue to need it—will hurt them when they need continuity of care the most.
There is a better way to handle Medicaid eligibility: Provide 12-month continuous coverage and align Medicaid with Medicare and commercial coverage. Redetermine everyone's eligibility just once a year.
A bill in Congress aims to do just that. In the House, Reps. Joe Kennedy (D-Mass.) and John Katko (R-N.Y.) last year introduced the bipartisan Stabilize Medicaid and CHIP Coverage Act of 2019. Sen. Sherrod Brown (D-Ohio) introduced companion legislation in the Senate. The bills would provide 12-month continuous eligibility for all enrollees in Medicaid and the Children's Health Insurance Program. And just this week the House passed the Patient Protection and Affordable Care Enhancement Act, which if enacted would require 12-month continuous eligibility for everyone on Medicaid and CHIP, and in particular for pregnant and postpartum women.
The health benefits of this policy are made clear in a new study from the Milken Institute School of Public Health at George Washington University. This study compares outcomes for children living in the 24 states that offer 12-month continuous eligibility for children with those living in the 26 states (and the District of Columbia) that do not. The study found if those 26 states (plus D.C.) also adopted continuous eligibility policies, then:
- 162,000 more low-income children would be able to see a specialist for medical care, such as an oncologist, allergist or infectious-disease doctor) in a year
- 81,000 fewer children would have an unmet need for specialty care
- 291,000 more low-income children would have at least one preventive health visit, such as a well-child visit or a vaccination
- 259,000 fewer children would have any gaps in health insurance coverage over the course of a year
Continuous Medicaid eligibility would close some of the yawning gaps in our insurance system that rising unemployment is making painfully obvious and ensure better access to care for a longer period. If continuous eligibility is serving Americans well during the pandemic, why cast it aside after? Congress, make the temporary fix permanent.