Healthcare organizations ask Congress for continuous Medicaid eligibility
Nationwide policy of 12-month continuous eligibility would allow these programs to operate more like private coverage and Medicare, letter says.
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A group of 188 federal and state organizations have sent a joint letter to Congressional and committee leadership urging them to support 12-month continuous eligibility for adults enrolled in Medicaid and the Children's Health Insurance Program.
Specifically, the letter asks Congress to enact the Stabilize Medicaid and CHIP Coverage Act, H.R. 5434 and S. 3138. The latest action on the bill was in September 2023, when the House referred it to the Subcommittee on Health, according to Congress.gov.
The groups signing the letter represent healthcare consumers, payers and providers including the Alliance of Community Health Plans, the American Academy of Family Physicians, America's Essential Hospitals and Trinity Health.
WHY THIS MATTERS
Millions of enrollees lose Medicaid coverage within a year, according to the letter, despite often still being eligible and reenrolling within a few months.
This is often caused by inefficient paperwork, overly burdensome reporting requirements or temporary income fluctuations, according to the groups.
Currently, adults on Medicaid are covered for less than 12 months of the year, the groups said. The non-elderly, non-disabled adults are only covered for about 8.6 months in a given year, while older adults and enrollees with disabilities are covered for about 10 months.
The Consolidated Appropriations Act of 2023 requires states to provide 12 months of continuous eligibility for Medicaid and CHIP enrollees under the age of 19. The law also makes permanent the state plan option to provide 12 months of postpartum coverage in Medicaid and CHIP.
Most of those losing Medicaid coverage do not transition to another form of insurance through the Affordable Care Act marketplace or employer-sponsored coverage, and become uninsured. Communities of color are the most likely to experience income volatility each year, and therefore are most likely to experience short periods of uninsurance before churning once again onto Medicaid, according to the letter.
Continuous eligibility is shown to improve health outcomes. Providers see relief in having patients retain their coverage.
A nationwide policy of 12-month continuous eligibility for all adults in Medicaid and CHIP would allow for continuous and stable enrollment and for these programs to operate more like private coverage and Medicare.
Coverage gaps raise the average monthly cost associated with covering a Medicaid enrollee and result in higher avoidable administrative costs for states, healthcare providers and health plans, the letter said. Recent research has also found that households would save $1 billion in healthcare costs if 12-month continuous eligibility were enacted for adults, the letter said.
Stability in Medicaid and CHIP coverage will reduce bureaucracy for states that currently conduct repeated eligibility determinations for enrollees and relieve excessive burden on providers, the letter said.
THE LARGER TREND
States administer Medicaid, a program that is jointly funded by the federal government and states.
Continuous eligibility for Medicaid was in effect during the public health emergency of the COVID-19 pandemic, when the federal government provided the funding.
Just before the PHE and federal funding ended in May 2023, states began the Medicaid redetermination process. An estimated 16 million people lost their Medicaid coverage.
Support for continuous eligibility continues to grow, according to the letter. Five states already provide 12-month continuous eligibility to all or some adults and more states are pursuing the policy as a means to ensure eligible enrollees retain their coverage.
Medicaid and CHIP provide health coverage to more than 80 million Americans.
ON THE RECORD
"The staggering disenrollment rate during the Medicaid unwinding only increases the urgency to put in place strong state policies to keep people covered. Communities of color are especially vulnerable to fall through cracks in coverage," said Anthony Wright, Families USA incoming executive director.
"Gaps in coverage can be the difference between life and death, as people caught in the churn have worse access to treatments, delay needed care and end up in the emergency department more often."
"We are grateful for Congress' work in passing nationwide 12-month continuous eligibility for all children in Medicaid and CHIP through the Consolidated Appropriations Act of 2023," said Jennifer McGuigan Babcock, senior vice president for Medicaid Policy at ACAP. "We now ask that this protection be extended to adults. No one should fear losing their access to comprehensive healthcare due to missing paperwork or fluctuations in income due to working a few extra hours in a given month or by picking up an additional shift."
Email the writer: SMorse@himss.org
