On Thursday, two states called for federal funding and advance notice of the end of the public health emergency related to COVID-19 so they can plan to resume Medicaid eligibility re-evaluation after a long pause.
Ending the public health emergency will create an enormous amount of work for state Medicaid agencies and related departments. Agencies are suffering from the same labor shortages and high turnover as other industries right now, said Jeff Nelson, director of the Utah Department of Health’s Eligibility Policy Bureau, and Jeremy Vandehy, director of Oregon Health’s Health Policy and Analytics Division. Authority at the Medicaid and CHIP Payments and Access Commission meeting.
States had to maintain their Medicaid rosters during the COVID-19 public health emergency in order to access expanded federal Medicaid funding. As a result, Medicaid enrollment hit an all-time high last year.
This requirement should end after a public health emergency, and federal officials have said they will give at least 60 days’ notice before the status expires. The public health emergency has now been extended until April.
But states could benefit from even more advance notice, Nelson said. The federal government’s warning will allow agencies to step up pre-determination activity, which could make the actual renewal smoother.
A provision in the Better Recovery Act, which was passed by the House of Representatives but apparently not passed by the Senate, would separate the end of continuous enrollment requirements from the public health emergency. Under this provision, additional funding will be terminated and states will be required to begin redefinitions starting in April 2022, regardless of pandemic status.
“It’s great that the public health emergency has been extended. However, if it is extended again, we really need to know what it looks like,” Vandehi said.
In December 2020, the Trump administration released guidance saying that 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 rules, giving states a full year to close the gap. The states are grateful for the extra six months, but it’s still not enough, Nelson said.
To complicate matters further, the increased federal funds allocated to maintain Medicaid listings during the pandemic will only last for the quarter in which the public health emergency ends.
“We’re not losing sight of the fact that we’re not being paid for this period of time,” Nelson said, adding that officials in Utah have proposed requiring the redefinition be completed in a shorter timeframe than federal leadership allows, although the idea is not t has been accepted by the state for now.
Commissioner Brian Burwell, vice president of health policy and research at technology consultancy Ventech Solutions, said he needed more information about states’ financial position as they solicit more federal Medicaid funds. Some states are running deficits, but he’s working with one state he didn’t name that has an $8 billion surplus for fiscal year 2022, he said.
But states are asking for funding to get back to normal after a federal requirement that triggered big systemic changes, and that seems like a reasonable request, said Commissioner Darin Gordon, a health care consultant and former director of Medicaid in Tennessee.
Government officials and beneficiary advocates also remain concerned about the number of people who could lose their health insurance when the overrides begin. Experts expect many eligible people to lose insurance due to administrative oversights.
Centers for Medicare and Medicaid compliance needs to be improved to help minimize the number of people who end up uninsured, Melissa McChesney, health policy adviser at civil rights organization UnidosUS, told MACPAC.
Forecasters in Oregon predict that about 300,000 people will lose insurance during the reprieve following the public health emergency, Vandehey added. He expects many to return to Medicaid at some point in the future.
As a result, the State of Oregon is looking at ways to continually change policies to stabilize coverage, such as implementing the Basic Health Program, which offers coverage to individuals whose incomes may fluctuate based on Medicaid eligibility, and reassesses every two years, and not annually, he said.
At the end of the meeting, the Medicaid counselors agreed that re-eligibility re-evaluation is an important topic to watch, but did not plan to take any action on this at this time.