Majority of Americans unaware of Medicaid eligibility redeterminations

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The majority of adult Medicaid beneficiaries are unaware that their future eligibility could be in question upon the close of the national COVID-19 public health emergency, according to new findings from the Robert Wood Johnson Foundation.

The issue stems from the Families First Coronavirus Response Act, enacted in March 2020, which established a Medicaid continuous coverage requirement, prohibiting states from disenrolling people during the PHE, in exchange for enhanced federal Medicaid funding. 

After the PHE expires, state Medicaid agencies will resume regular renewals. Last week, the administration indicated it would extend the PHE beyond January 2023, signaling a potential end date in the spring.

Millions are projected to be at risk of losing Medicaid after the PHE ends, because of the end of the continuous enrollment requirement put in place under the emergency. These consumers either are no longer eligible or remain eligible but may need to take action, such as updating documentation, to remain enrolled, the report found.

Using June 2022 Health Reform Monitoring Survey data, 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.

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.

Among the 37% of adults who had heard at least a little about the resumption of renewals, the most common source of information received was media, including social media, television, radio and newspapers (34.3%). The next most common information source was a state agency (30.6%); followed by a health insurance company or plan (24.5%); a doctor's office, clinic, hospital or other healthcare provider (17.8%); or somewhere else (6.5%).

Of those who had heard about the forthcoming change from state agencies or health plans, the information provided was most commonly a notification of the need to renew coverage (50.4%). The next most common were requests to verify one's address or other contact information (36.4%), or to verify or update income or other factors that may affect eligibility (34.4%). 

Smaller shares reported receiving information about other coverage sources (29.1%) or how to get consumer assistance during the renewal process (21.3%).

WHAT'S THE IMPACT?

Low awareness of the resumption of Medicaid renewals indicates state programs may face significant information gaps among enrollees about the looming change, the report found. And effective communication on this issue is challenging given that a specific date for the end of the PHE has not been set and is still pending. 

It's another challenge for hospitals, which are already facing the end of waivers when the public health emergency is lifted. Beneficiaries, now covered by Medicaid, may be uninsured when going in for care or to the ER, resulting in greater risk to hospitals of uncompensated care.

But Medicaid agencies have several tools to simplify renewals, such as renewing some enrollees' coverage automatically, and are required to develop plans for the PHE unwinding. 

It will be critical, authors said, that they take advantage of these tools to ensure enrollees who remain eligible do not unnecessarily lose coverage and that those losing eligibility are linked to other affordable coverage, such as that available through the marketplaces.

Among respondents at least a little familiar with the resumption of Medicaid renewals, the most common information source was media or social media, indicating that other information sources, especially state Medicaid agencies, could play a larger role in communicating the change and implications for enrollees. 

Moreover, just one in five respondents who had heard from a state agency or health plan about the upcoming change got a notification about available consumer assistance; such information may need to become more widely available, given the importance of assistance in helping enrollees navigate renewal. 

That many people projected to lose Medicaid after the PHE will no longer be eligible for the program, and that fewer than a third of respondents had received information about other coverage options, shows the importance of connecting people to other coverage sources to minimize increases in uninsurance.

THE LARGER TREND

The Department of Health and Human Services had told providers it would give them 60 days notice before the end of the PHE. Since the deadline for that was last Friday, the assumption is that the PHE will be extended, with a new deadline anticipated in April.

The PHE keeps waivers and policies in place for Medicaid coverage, telehealth coverage, and add-on payments to hospitals and physicians. Telehealth waivers will expire 151 days after the end of PHE.

An estimated 15 million people could lose Medicaid coverage when the COVID-19 public health emergency ends, and with it the continuous-enrollment requirement.

Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com