AHIP pushes education on Medicaid redeterminations

Photo: Tempura/Getty Images

AHIP hosted a State of the Industry briefing Wednesday detailing the policies the group will be watching in 2023, as well as the challenges facing the healthcare industry. AHIP President and CEO Matt Eyles carved out time to talk about the resumption of Medicaid redeterminations, which were set to kick in upon the expiration of the COVID-19 public health emergency.

It was a timely issue for the group. In December, President Biden signed into law a $1.7 trillion omnibus spending package that detailed a plan for Medicaid coverage determinations. 

Under the bill, states will be able to begin processing Medicaid redeterminations on April 1, and have one year to complete them. It requires state Medicaid programs to provide 12 months of continuous coverage for children and permanently allow states to offer 12 months of coverage for postpartum women, according to the American Hospital Association.

An estimated 18 million people are expected to lose their Medicaid coverage after the continuous enrollment provision ends. That was to end with the expiration of the public health emergency, but the omnibus bill kick-starts that on April 1. HHS Secretary Xavier Becerra extended the PHE for a 12th time on Wednesday.

"Since the COVID-19 crisis, the number of people who rely on Medicaid has grown substantially," said Eyles. "Almost 90 million Americans have access to coverage through Medicaid, protected in 2019 by pausing redeterminations. With the passage of the recent omnibus bill, Medicaid redeterminations can begin April 1 regardless of when the PHE ends.

"If it expires in April, 18 million Americans will lose Medicaid coverage in the following 18 months," he said. "Many don't know this coverage can be terminated when states begin their renewal process. It needs to be done in a manner so that people needing it are transitioned to other coverage."

Eyles said states should engage with enrollees and ensure a smooth transition to other types of coverage, including marketplace and employer-sponsored coverage.

Currently, HHS has announced no plan to allow Medicaid beneficiaries who lose their coverage to enroll in an Affordable Care Act marketplace plan through a special enrollment period.

Indeed, findings published in January by the Robert Wood Johnson foundation found most adults with family Medicaid enrollment were not aware of the return to regular Medicaid renewals when the PHE expires. When asked how much they had heard about their state restarting renewals, 5% of respondents had heard a lot, 16.2% had heard some, 15.7% had heard only a little, and 62% had heard nothing at all.

Awareness was not significantly higher among those who had enrolled since the continuous coverage requirement took effect – a group that may not have had experience with states' redeterminations and may require more assistance.

DRUGS, CONSOLIDATION

Eyles also touched on consolidation in healthcare, saying the insurance industry should focus on competition and the role it can play in choice, access and quality. 

"Hospital concentration is linked to marketplace premiums that are 5% higher than in less concentrated areas," said Eyles. 

He also called for more accountability from the pharmaceutical industry.

"A therapy is useless if nobody can afford it," said Eyles. "The problem is the price, and we still think that's very true. Prices are set and controlled by big pharma and big pharma alone, and if they wanted to reduce prices, they could do so now. But they're increasing prices on old drugs instead, making drugs and insurance more expensive for everyone. Generics and biosimilars save money, but big pharma takes advantage of a broken system. Stakeholders can hold big pharma accountable."

With a Republican-controlled House and a Democratic-controlled Senate, Eyes acknowledged that many Americans are concerned that the next two years in Washington will be mired in gridlock. Eyles, though, saw a path to some agreement for the nation's lawmakers.

"I'm generally optimistic that there are some key areas of agreement and common ground, and several of them are in healthcare," he said.
 

Twitter: @JELagasse
Email the writer: Jeff.Lagasse@himssmedia.com