Millions at risk of losing Medicaid in spring with $1.7 trillion federal spending bill

Millions of people who enrolled in the public health insurance program Medicaid during the Covid pandemic could lose their coverage in the spring if their state determines they no longer meet the program’s eligibility requirements.

Medicaid enrollments jumped 30% to more than 83 million people during the pandemic, after Congress essentially barred states from expelling people from the program for the duration of the federal public health emergency declared in response to covid.

Tucked away in a more than 4,000-page, $1.7 trillion bill that funds the federal government through September is a provision that would eliminate Medicaid coverage protections from the public health emergency. Instead, states could begin terminating beneficiary coverage in April 2023 if they no longer meet the program’s eligibility criteria.

“As of April 1, Medicaid agencies conducting reassessments for those enrolled in the program may result in termination of Medicaid coverage,” said Jack Rollins, director of federal policy at the National Association of Medicaid Directors. “While at this time since the start of the Covid-19 public health emergency, states were not permitted to terminate Medicaid coverage.”

Congress must pass the legislation by Friday to avoid a government shutdown.

The public health emergencyi, first declared in January 2020 by the Trump administration, has been renewed every 90 days since the start of the pandemic. The powers enabled by the emergency declaration have had a huge impact on the US health care system, allowing hospitals to act more quickly when infections rise and allowing Medicaid to keep millions of people enrolled in its public health insurance.

The Department of Health and Human Services has estimated that about 15 million people will lose their Medicaid coverage once enrollment protections are no longer in place and states review individuals’ eligibility based on criteria. used before the pandemic. Medicaid is the federal insurance program for the poor and those who lose their health insurance because they cannot work due to a disability.

“It’s important to contextualize that losing Medicaid coverage doesn’t necessarily mean losing health insurance coverage,” Rollins said. “A lot of these people will move on to other sources of coverage.”

People typically lose Medicaid coverage if their income rises and falls outside program parameters. Rollins said most of those unenrolled for this reason starting in April will likely transition to coverage of the Affordable Care Act markets. HHS estimates that about one-third of those who lose Medicaid coverage will qualify for market insurance tax credits.

But some people are opted out even though they remain eligible for Medicaid because they don’t receive their renewal notice, can’t provide state-required documents, or don’t submit documents by the deadline, among other reasons. HHS has estimated that 6.8 million people will lose their Medicaid coverage even if they remain eligible for the program.

“There needs to be a process to renew coverage or redetermine coverage and de-enroll people who are no longer eligible,” said Jennifer Tolbert, Medicaid expert at the Kaiser Family Foundation.

“The key is to do this in a way that minimizes coverage losses as much as possible among people who remain eligible,” Tolbert said.

The legislation requires states to make good faith efforts to contact the person whose eligibility is under review through more than one method of communication. States cannot terminate a person’s Medicaid coverage based solely on mail returned in response to outreach efforts.

“We try to make sure that states have the most up-to-date contact information for their enrollees,” Rollins said. “Because we know that without accurate contact information it increases the likelihood of inappropriate or unnecessary loss of coverage and that’s something we strive to avoid.”

Republican governors on Monday called on the Biden administration to end the public health emergency from Covid in April so their states can begin unenrolling people who no longer meet Medicaid eligibility requirements, arguing that the costs of higher enrollment in the program are too high.

However, Tolbert said KFF found states spent about $47 billion to cover additional Medicaid enrollees through September 2022 when they received $100 billion in federal funds.

“The costs were more than covered by the enhanced federal funding,” Tolbert said.