Two states on Thursday called for federal funds and advance notice of the COVID-19 public health emergency's end so they can plan to resume Medicaid eligibility redeterminations after a long pause.
The end of the public health emergency will create an enormous amount of work for state Medicaid agencies and related departments. The agencies suffer from the same workforce shortages and high turnover seen in other industries right now, said Jeff Nelson, bureau director of eligibility policy for the Utah Department of Health, and Jeremy Vandehey, director of the health policy and analytics division for the Oregon Health Authority at a Medicaid and CHIP Payment and Access Commission meeting.
States have had to maintain their Medicaid rolls during the COVID-19 public health emergency in order to access enhanced federal Medicaid funding. As a result, Medicaid enrollment reached record highs by last year.
This requirement is set to end with the public health emergency, and federal officials have said they'll give at least 60 days' notice before letting the designation expire. The public health emergency is currently extended until April.
But states could benefit from even more advance notice, Nelson said. A heads-up from the federal government would allow agencies to ramp up pre-determination activities, which could make actual renewals go smoother.
A provision in the Build Back Better Act, which passed the House of Representatives but appears to be dead in the Senate, would have decoupled the end of continuous enrollment requirements from the public health emergency. Under the provision, the extra funding would be phased out and states would have to begin redeterminations starting in April 2022, regardless of the pandemic's status.
"It's great that the public health emergency was extended. If it's going to be extended again, though, we really need to know what that looks like," Vandehey said.
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The Trump administration released guidance in December 2020 that said states would have six months after the end of the public health emergency to resume their regular coverage renewal processes. The Biden administration later changed the guidelines, giving states a full year to take care of the backlog. States are grateful for the extra six months, but it's still not enough, Nelson said.
To complicate matters further, the bolstered federal funds that come with maintaining Medicaid rolls during the pandemic will only last through the quarter in which the public health emergency ends.
"The point is not lost on us that we're not getting paid for that period of time," Nelson said, adding that officials in Utah have proposed requiring redeterminations to be finishing within a shorter timeframe than federal guidance allows, though the idea hasn't been adopted by the state at this point.
Commissioner Brian Burwell, vice president of healthcare policy and research at technology consulting company Ventech Solutions, said he wants more information on states' financial situations as they ask for more federal Medicaid funds. Some states are in a deficit, but he's working with one state, which he did not name, that has an $8 billion surplus for fiscal 2022, he said.
But states are asking for funding to get back to normal operations after a federal requirement that caused big system changes, and that seems like a reasonable request, said Commissioner Darin Gordon, a healthcare consultant and former Tennessee Medicaid director.
State officials and beneficiary advocates also remain concerned about the number of people who could lose their health coverage when redeterminations begin. Experts expect many eligible people to lose coverage because of administrative oversights.
Better enforcement of requirements by the Centers for Medicare and Medicaid Services is needed to help minimize the number of people who end up going uninsured, Melissa McChesney, health policy adviser at civil rights organization UnidosUS, told MACPAC.
Forecasters in Oregon predict about 300,000 people will lose coverage during their redeterminations after the public health emergency, Vandehey added. He expects many to come back to Medicaid at some point in the future.
Because of this, Oregon is looking into ways to permanently change policies to stabilize coverage, like implementing a Basic Health Program that offers coverage to individuals whose incomes may fluctuate around Medicaid eligibility levels and conducting redeterminations every two years instead of annually, he said.
Medicaid advisers agreed at the end of the meeting that resuming eligibility redeterminations is an important topic to watch but did not plan to take any action on it at this time.