Omnibus spending bill gives states a heads-up on Medicaid coverage

Photo: Joe Daniel Price/Getty Images

Among the many health provisions of the $1.7 trillion omnibus spending package that passed on Friday is a long-awaited plan for Medicaid coverage determinations.

An estimated 18 million people are expected to lose their Medicaid coverage after the continuous enrollment provision ends with the expiration of the public health emergency. The PHE currently expires in mid-January but is expected to be extended to give providers their promised 60-day notice.

Under the bill, states will be able to begin processing Medicaid redeterminations on April 1, 2023 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.

Effective January 1, 2024, the legislation will require states to ensure that children determined eligible for Medicaid receive continuous eligibility for 12 months.

WHY THIS MATTERS

Under the bill, states can begin disenrolling people from Medicaid in April even if the public-health emergency designation remains in place, according to The Wall Street Journal.

But as the continuous enrollment requirement was set to end at the end of the PHE, which would be in mid-April if extended for another 90 days, the bill gives states a heads-up on starting the redetermination process. Those no longer eligible for Medicaid could gain coverage through the Affordable Care Act.

This would mean fewer people losing their health insurance coverage and getting uncompensated care. 

Under this new approach, states will continue to have access to the enhanced Federal Medicaid Assistance Percentage through December 31, 2023 while conducting redeterminations, subject to certain conditions, the AHA said. The enhanced FMAP will fully sunset on January 1, 2024.

THE LARGER TREND

Most Medicaid beneficiaries are unaware that their coverage could come to an end with the public health emergency, according to the Robert Wood Johnson Foundation.

RWJ 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, the report said.

Because of this, upwards of 18 million people could lose Medicaid coverage, and four million people could become uninsured entirely when the COVID-19 public health emergency expires, according to the Urban Institute.

Twitter: @SusanJMorse
Email the writer: SMorse@himss.org