ACP Advocating for Smooth Medicaid 'Unwinding' Process, Calls for Improvements to Marketplace-Based Coverage

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Feb. 10, 2023 (ACP) — As part of the end-of-year spending bill, Congress set an end date for the Medicaid continuous enrollment provision required by the Families First Coronavirus Response Act. The American College of Physicians is concerned that millions of people may lose Medicaid coverage after March 31, when the continuous enrollment condition is now set to expire.

“According to one estimate, one-third of Medicaid enrollees who lose coverage after the end of the COVID-19 public health emergency may qualify for subsidized Exchange-based coverage. We support additional options to prevent coverage gaps,” Dr. Ryan Mire, president of ACP, wrote in a Jan. 30 letter to Xavier Becerra, secretary of the U.S. Department of Health and Human Services.

During the COVID-19 public health emergency, the federal government increased the amount of funding it provided to state Medicaid programs, explained Ryan Crowley, ACP senior associate for health policy. “In return, states had to provide continuous coverage to Medicaid enrollees,” he said. “That means they couldn't kick people off the program or make changes that would result in people losing their coverage. But states can start removing ineligible people from the program once the public health emergency ends during an ‘unwinding’ period.”

The spending bill designates March 31, 2023, as the end of the continuous enrollment condition period, allowing states to start disenrolling people from Medicaid starting on or after April 1. “This will be a really challenging process and could result in millions of people losing their coverage,” Crowley said. “The Kaiser Family Foundation estimates that between 5 and 14 million people could lose coverage during the unwinding period. Some will lose coverage because they aren't eligible, but others will lose coverage because of administrative errors or outdated contact information. Many people will likely be uninsured for all or some of the following 12 months.”

ACP is supporting a proposed federal regulation that would designate a longer special enrollment period for people who lose their Medicaid or Children's Health Insurance Plan coverage. Health insurance marketplaces (also known as exchanges) would also have the option to change the date that coverage starts for people who expect to lose coverage in the future.

“In addition to the special enrollment period changes, the rule proposes to allow coverage assisters to visit people at their homes to answer coverage questions and help with enrollment,” Crowley said. “There are also provisions to improve standardized plans, which intend to simplify insurance and make it easier to compare marketplace-based plans based on quality, networks and other characteristics.”

The final regulation will be released in the next few months, and open enrollment for the 2024 plan year will start in November 2023. For now, Crowley said, “physicians can help by informing their Medicaid-enrolled patients of the unwinding period and urging them to update their contact information, check their mail for information and renewal forms from their Medicaid agency, and fill out any necessary renewal forms so they stay enrolled in coverage. If they lose Medicaid, they may be eligible for marketplace-based coverage.”

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