Hospitals need a battle plan for end of Medicaid's continuous coverage

Photo: Reza Estakhrian/Getty Images

Up to 18 million Medicaid beneficiaries are projected to lose coverage when states begin the redetermination process for coverage starting on April 1 and after the current and likely last public health emergency ends on April 11. 

This likely means a gap in coverage for those who had Medicaid through the public health emergency's continuous enrollment requirement, before or even if they get other coverage such as through an Affordable Care Act plan, according to Jonathan Wiik, VP Healthcare Insights, FinThrive, a software-as-a-service company. 

Hospitals need to act now to educate patients on Medicaid redeterminations and options for coverage to avoid uncompensated care or seeing uninsured patients when they're really sick, Wiik said. Staff working in registration need to talk to patients about eligibility and administrators need to work with their states and review their financial assistance programs, he said.

"You've got to have a battle plan," Wiik said.

AHIP is also pushing for education on Medicaid redeterminations.

Health and Human Services Secretary Xavier Becerra extended the public health emergency on Wednesday for the 12th time. It is expected to be the last extension, ending the PHE on April 11.

HHS has promised to give providers 60 days' notice before ending the public health emergency. That date would be February 10.

WHY THIS MATTERS

Wiik believes the number of Medicaid beneficiaries losing their coverage will be around 15 million, rather than 18 million. The number of those absolutely losing coverage is expected to be around 8.2 million, and some will not reapply even if they qualify for Medicaid, he said.

Losing coverage is a qualifying event that entitles Medicaid beneficiaries to apply for ACA plans or any plan outside of the open enrollment, Wiik said.  Exchange plans are expected to be a top option due to tax subsidies that allow four out of five consumers to get health insurance coverage for $10 a month.

However, Wiik said, there will be an expected gap in coverage after the PHE expires, ending the continuous enrollment requirement, prior to any planned continuation of coverage.

THE LARGER TREND

States want the Biden Administration to end the public health emergency due to lack of funding for their Medicaid programs.

On December 19, 25 governors sent a letter to President Biden asking him to end the public health emergency in April.

"The PHE is negatively affecting states, primarily by artificially growing our population covered under Medicaid (both traditional and expanded populations), regardless of whether individuals continue to be eligible under the program," the letter said. "While the enhanced federal match provides some assistance to blunt the increasing costs due to higher enrollment numbers in our Medicaid programs, states are required to increase our non-federal match to adequately cover all enrollees and cannot disenroll members from the program unless they do so voluntarily. Making the situation worse, we know that a considerable number of individuals have returned to employer sponsored coverage or are receiving coverage through the individual market, and yet states still must still account and pay for their Medicaid enrollment in our non-federal share. This is costing states hundreds of millions of dollars."

After the letter was written, Congress passed the omnibus spending package that included a provision for states to begin processing Medicaid redeterminations on April 1, giving them one year to complete them.

"States have got to stop enrolling people with the money turned off," Wiik said. "States are worried about not being able to fund claims."

The federal matching percentage (FMAP) bump ends on December 31. The financial bump was given for states to help people stay covered and removed a lot of the barriers to enroll in Medicaid and CHIP.

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