States are preparing to remove millions from Medicaid as protective measures introduced early in the covid-19 pandemic expire.
The upheaval, which begins in April, will put millions of low-income Americans at risk of losing health insurance, threatening their ability to access care and potentially costing them medical bills. Large medical bills.
It will also put financial pressure on hospitals, doctors and others that rely on payments from Medicaid, the state’s federal program that pays low-income people and people with disabilities. .
Related: What ending the federal COVID-19 emergency means for healthcare
Nearly three years ago, as covid sent the economy into freefall, the federal government agreed to send billions of dollars more in Medicaid funding to states on condition they stopped dropping people off their lists.
But legislation enacted in December will phase out that amount over the next year and call on states to continue cutting Medicaid benefits for people who no longer qualify.
Now, states face big challenges: making sure they don’t unenroll those still on Medicaid and connecting those who remain to other sources of coverage.
Even before the pandemic, states were struggling to stay in touch with Medicaid recipients, who in some cases didn’t have a stable address or internet service, didn’t speak English, or didn’t speak English. Prioritize health insurance for more urgent needs.
“We have no illusions that this will be pretty or graceful, but we will do everything we can to not lose anyone in the process,” said Dana Hittle, interim director of Medicaid for Oregon, talk about the so-called Medicaid cancellation.
With the uninsured rate of Americans at an all-time low of 8%, the reversal would be painful.
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The Biden administration has predicted that 15 million people — 17% of enrollees — will lose coverage through Medicaid or CHIP, the closely related Children’s Health Insurance Program, as these programs become operational again. back to normal. While many of the 15 million people will be disqualified because they are no longer eligible, nearly half will be disqualified for procedural reasons, such as failure to meet personal information update requirements, a federal report said.
Some states could be particularly hard hit: Nevada’s Medicaid and CHIP enrollments have grown 47% since February 2020. More people signed up at the start of the pandemic, when the unemployment rate was The state’s industry jumped nearly 30%.
Usually, people move in and out of Medicaid all the time. States that have considerable flexibility in how they run their Medicaid programs, often experience significant “flush” as people’s incomes change and they gain or lose their ability eligibility.
The disassembly will take place over a year.
People who lose their Medicaid coverage — in more than 30 federally insured states — will have until July 31, 2024 to sign up for ACA coverage, CMS announced January 27. whether state-based marketplaces offer the same extended enrollment opening times.
Even states that are taking sweeping actions to make sure people don’t fall uninsured worry that the transition will be difficult.
In California alone, the state government predicts that at least 2 million of the 15 million people enrolled in the program today will lose Medicaid coverage because of ineligibility or failure to reapply.
“We acknowledge that this is going to be a bumpy road,” said California Health and Human Services Secretary Mark Ghaly. “We’re doing all we can to prepare.”
In a joint effort, states are enlisting Medicaid health plans, doctors, hospitals, state insurance markets and a variety of nonprofit groups, including schools and churches, to reach people at risk of losing coverage.
States will also use social media, television, radio and billboards, as well as websites and mobile apps to connect with subscribers. That’s in addition to mail and email.
Nevada has developed a mobile app to communicate with members, but only 15,000 of the 900,000 Medicaid enrollees have signed up to date.
“[T]The transient nature of Nevada’s population means that it is difficult to maintain proper communications,” a state report said in November. At least 1 in 4 letters sent to registrants has failed. returned due to wrong address.
Law that allows states to begin unsubscribing ineligible Medicaid recipients on April 1 prohibits states from unregistering anyone because a bounce is undeliverable until the state does “good faith effort” to contact the person in at least another way, such as by phone or email.
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To ease disruption even further, the law requires states to cover children in Medicaid and CHIP for 12 months regardless of circumstances, but that provision has not been in effect for nearly a year. .
Jack Rollins, federal policy director at the National Association of Medicaid Directors, said states will give Medicaid recipients at least 60 days to respond to requests for information before dismissing them.
States will use government databases, such as those from the IRS and Social Security Administration, to check applicants’ income eligibility so they can automatically extend coverage for certain people without having to contact them. But some states are not taking full advantage of the database.
States have until February to submit their removal plans to the federal Centers for Medicare & Medicaid Services, which will oversee the process.
But it’s clear that some states are doing more than others to keep people insured.
Oregon plans to allow children to stay on Medicaid until age 6 and allow others to qualify for up to two years regardless of income changes and without the need to reapply. No other state offers more than a year of eligibility guarantee.
State officials said Oregon is also creating a subsidized health insurance program to cover anyone who is no longer eligible for Medicaid but has an annual income below 200% of the federal poverty level. state, or about $29,000 for an individual, state officials said. The program will have the same benefits as Medicaid at low or no cost to enrollees.
Rhode Island will automatically transfer people who no longer qualify for Medicaid — and have an annual income below 200% of the poverty rate — to the Affordable Care Act program and pay the first two months of premiums. their. State officials hope the change will go smoothly for many enrollees as they will switch between health plans run by the same company.
California will move some people to the state’s market-subsidized private program, Covered California. Subscribers will have to agree and pay a premium if they don’t qualify for a free plan. However, premiums can be as low as $10 a month, says Jessica Altman, chief executive officer of Covered California. (Altman’s father, Drew Altman, is the president and chief executive officer of the KFF. KHN is an independent editorial program of the KFF.)
“We want to make it easier to say yes to coverage,” says Altman.
But experts worry about what will happen to Medicaid enrollees in Florida.
Florida does not have its own ACA market. As in most states, its residents use the federal exchange to purchase ACA packages. Jodi Ray, director of Florida Covering Kids and Family, a nonprofit that helps people find coverage.
Another concern for advocates is that Florida uses less government databases than other states to check registrant income. “We make people go through challenging rounds to re-register instead of using all the accepted data,” says Ray.
Florida typically takes several weeks to process Medicaid applications, she said, while some states do it in a day.
Florida’s unwinding plan illustrates the difficulty of reaching subscribers. The plan says that as of 2020, the state has identified 850,000 cases of Medicaid recipients who failed to respond to requests for information.
Florida Medicaid officials did not return calls for comment.
While state officials struggle to manage the disassembly, health care providers are bracing for the consequences.
Dennis Sulser, chief executive officer of Montana-based Billings, Youth Dynamics, which provides mental health services to many children on Medicaid, thinks some children will lose coverage because get lost in the process.
That can leave patients unable to pay and nonprofits straining financially to try to prevent children from facing treatment interruptions.
“If we have to discharge a child who is being cared for in our group home and they are only halfway through learning and do not have all the fundamentals of the necessary care support, then that could be a tragedy,” Sulser said.
KHN reporter Daniel Chang in Hollywood, Florida; Angela Hart of Sacramento, California; Katheryn Houghton of Missoula, Montana; Bram Sable-Smith of St. Louis; and Sam Whitehead of Atlanta contributed to this report.
Kaiser Health News is a national health policy news service. This is an editorially independent program of the Henry J. Kaiser Family Foundation not affiliated with Kaiser Permanente.
