Medicaid Is Unwinding: Are Your Patients Prepared?

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With the end of the continuous enrollment policy, ACP urges members to make patients aware that they need to renew their Medicaid coverage

Aug. 11, 2023 (ACP) — Public health experts are bracing for what is likely to be the biggest health insurance coverage change in the United States since was launched in 2013: the unwinding of Medicaid protections put in place at the beginning of the COVID-19 pandemic.

To help weather this storm, the American College of Physicians is calling on the Centers for Medicare & Medicaid Services (CMS) to provide clarity on the process and is encouraging members to help ensure patients are actively trying to retain or renew health coverage.

At the beginning of the COVID-19 pandemic, Congress passed legislation requiring that states maintain continuous enrollment in Medicaid programs through the end of the COVID-19 public health emergency in exchange for enhanced federal funding. “In late 2022, Congress passed a bill terminating the continuous enrollment policy, requiring states to resume eligibility determinations in 2023,” explained Ryan Crowley, ACP senior associate for health policy.

More than 3.8 million people have already lost their Medicaid coverage as of Aug. 3, 2023, according to KFF, formerly the Kaiser Family Foundation. This is just in Washington, D.C., and the 41 states that have reported, so the actual number is likely much higher, Crowley said.

Earlier this year, ACP and other organizations sent a letter to Health and Human Services Secretary Xavier Becerra offering recommendations on how to prevent coverage losses due to procedural or administrative reasons.

“Most enrollees have lost coverage due to procedural reasons; for example, they may have moved and never received their Medicaid renewal forms,” Crowley explained. “That's particularly concerning because it means most people are still eligible for Medicaid but have lost coverage anyway.”

States have taken very different approaches for Medicaid unwinding, but nearly all have resumed Medicaid renewals, Crowley said. Many have elected to use existing information, like the Supplemental Nutrition Assistance Program enrollment information, or they are working with Medicaid-managed care plans to determine eligibility, which will help streamline the process.

ACP requested that CMS hold states accountable for underfunding call centers, implementing needlessly complex renewal processes and other actions to discourage Medicaid enrollment, according to Crowley. “We've asked CMS to give people transitioning from Medicaid to the Affordable Care Act marketplace coverage extra time and assistance to choose a plan,” he said.

Coverage transitions can be problematic. “Even if a person moves from Medicaid to an ACA marketplace-based plan, they may face different ‘provider’ networks, cost-sharing requirements and utilization management policies that could influence whether they're able to access or afford care,” Crowley said.

Making matters worse, most Medicaid enrollees do not know that the unwinding process has started. “Raising awareness and compelling them to act is key,” Crowley noted.

ACP members can take action to help patients stay covered, he said, including communicating to “Medicaid patients that the unwinding process is happening now and that they need to renew their coverage.”

And “they can encourage patients to make sure Medicaid or the Children's Health Insurance Program (CHIP) has their current address, phone number, email and other contact information,” he said.

It is also important to explain to patients that they check their mail for letters from Medicaid or CHIP about their coverage and complete renewal forms and send them to the appropriate agency as soon as they receive them, Crowley stressed.

“If patients are no longer eligible for Medicaid coverage, they may qualify for coverage through the ACA marketplace or Medicare,” he said. “Encourage patients to visit for more information about other coverage options.”

More Information

Resources for helping Medicaid patients keep their coverage are available on the ACP website.

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