Hospitals Need a Battle Plan to End Continuous Medicaid Coverage

Photo: Reza Estakhryan/Getty Images

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

According to Jonathan Wiik, vice president of health care, FinThrive, this likely means a gap in coverage for those who received Medicaid under the permanent enrollment requirement due to the public health emergency, before or even if they receive other coverage, such as through an Affordable Care Act plan. a software-as-a-service company.

Hospitals need to act now to educate patients about Medicaid redefinitions and coverage options to avoid uncompensated care or visiting uninsured patients when they are truly sick, Wiik said. Enrollment staff should talk to patients about eligibility, he said, and administrators should work with their states and review their financial assistance programs.

“You have to have a battle plan,” Wiik said.

AHIP is also pushing for education on redefining Medicaid.

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

HHS has promised to notify healthcare providers 60 days before the public health emergency ends. This date will be February 10th.

WHY IS IT IMPORTANT

Wiik believes that the number of Medicaid recipients who lose coverage will be about 15 million, not 18 million. The number of those who will lose coverage entirely is expected to be about 8.2 million, and some of them will not reapply even if they are eligible for Medicaid, he said.

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

However, after the PHE expires, there will be a gap in coverage, Viik said, removing the requirement to continue enrollment until any planned renewal of coverage.

BIG TREND

The states want the Biden administration to end the public health emergency due to lack of funding for their Medicaid programs.

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

“PHE is negatively impacting states, primarily by artificially increasing our Medicaid covered population (both traditional and extended populations), regardless of whether people continue to be eligible for the program,” the letter said. “While expanded federal compliance helps mitigate the rising costs of increasing enrollment in our Medicaid programs, states are required to increase our non-federal compliance to adequately cover all participants and cannot remove participants from the program if they fail to do so. To make matters worse, we know that a significant number of people have returned to employer-sponsored coverage or receive coverage through the individual marketplace, and yet states still must account for and pay for their Medicaid participation in our non-federal share. It’s costing the states hundreds of millions of dollars.”

After the letter was written, Congress passed a comprehensive spending package that included a provision that states must begin processing Medicaid re-determinations on April 1, giving them one year to complete them.

“States should stop registering people with money cut off,” Wiik said. “States are concerned they won’t be able to fund the claims.”

The federal match percentage increase (FMAP) ends on December 31st. The financial increase has been given to states to help people stay covered and remove the many barriers to Medicaid and CHIP enrollment.

Twitter: @SusanJMorse
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