Last week, the Department of Health and Human Services extended the COVID-19 public health emergency declaration for another 90 days, perhaps for the last time. For nearly two years, state Medicaid leaders have been actively preparing for the end of this declaration—an event that could trigger the largest health coverage changes since the Affordable Care Act.
The stakes are high, as millions could lose their Medicaid and Children’s Health Insurance Program coverage, with significant implications for equity and the healthcare safety net, specifically hospitals, clinics and federally qualified health centers.
The National Association of Medicaid Directors and the Robert Wood Johnson Foundation-funded State Health and Value Strategies Program have been helping state Medicaid leaders prepare. But the programs need continued partnership from the healthcare system and health industry leaders to assist states in this work and to help millions of people keep their Medicaid coverage or successfully transition to other sources of insurance.
The challenges for Medicaid
Medicaid programs across the country employed “continuous enrollment” at federal direction since the start of the pandemic, keeping most people enrolled in the program regardless of whether they became ineligible during the pandemic. As a result, Medicaid and CHIP enrollment grew from about 71 million adults and children to roughly 85 million.
With the end of the national health emergency declaration comes the requirement to redetermine eligibility for every individual receiving health insurance through Medicaid and CHIP. An estimated 16 million people might no longer meet eligibility requirements for Medicaid.
Many of those individuals will be eligible for other sources of coverage, either through their employers, the marketplaces or Medicare. State Medicaid programs will need the partnership of providers, payers and others in the healthcare system for a successful redetermination process and to help smoothly transition those who are not Medicaid-eligible to other sources of coverage. Without this, care will be disrupted and the number of uninsured will increase, putting additional strain on the healthcare safety net, especially rural hospitals and clinics, which are already facing historic challenges.
How programs are preparing
State Medicaid programs are deploying comprehensive approaches to communicate with members. According to an NAMD survey, three common outreach efforts include using texts and other direct messaging, leveraging relationships with contracted health plans, and/or working with community-based organizations such as food banks, faith-based organizations and homeless shelters. Massachusetts, for example, is supporting a community-based outreach campaign, which will be led by a local consumer organization. States like New Hampshire, Oklahoma and Virginia are also using social media to get the word out.
They are also preparing the workforce and their IT systems. Medicaid programs want to make sure state and county staff are ready for the surge in work that will be coming.
The healthcare system can help
Health industry leaders can take three actions now to support Medicaid programs and make sure affected people smoothly transition to other sources of coverage:
- Spread the word. States need healthcare providers, managed-care organizations, pharmacies, community-based organizations, and others to help get the word out to customers covered by Medicaid that their coverage could be affected and to share their current contact information with agencies. Providers, in particular, are trusted messengers.
- Make sure Medicaid programs are well-resourced. Workforce shortages facing states and counties are significant. Health system partners, particularly safety-net providers, can publicly advocate for Medicaid programs to be provided adequate funding so the programs can fill vacancies, expand capacity and ensure the workforce that conducts eligibility determinations is well trained.
- Seek federal clarity and continued support. The federal government’s ongoing partnership and transparency about the transition will be critical, including adequate advance notice about when the national health emergency will finally end. The agency has promised to give states at least 60-days’ notice before ending the declaration. A longer lead time would be better.
The pandemic’s evolution and uncertain trajectory make it difficult to predict if the public health emergency declaration will end in mid-July or if it will be extended again. But we shouldn’t wait to build partnerships to preserve access to care. Medicaid and CHIP are providing health insurance to 1 in 4 Americans. States need the help of health industry leaders to make sure millions of Americans can continue to get the coverage and healthcare they need.