Medicaid Directors Prepare for the End of the Public Health Emergency

Up to 14 million people with Medicaid coverage could lose their health insurance when the COVID-19 public health emergency ends.

Unless the coronavirus wreaks more havoc on the country’s health care system, the public health emergency (PHE) may end in the coming weeks or months. When that happens, the approximately 14 million Medicaid members who enrolled after PHE began in February 2020 could lose their health insurance.

The Coronavirus First Families Response Act of 2020 requires states to implement ongoing coverage requirements to ensure workers who have lost their jobs or employer-provided coverage get insurance through Medicaid or another source. The law also provided for a temporary 6.2% increase in federal Medicaid payments so that states can maintain ongoing Medicaid enrollment for nearly all enrollees.

This requirement was largely responsible for an increase of 20 % in joining the Medicaid and Health Insurance program (Chip) since February 2020. The Kaiser Family Foundation has been estimated at the number of Medicaid and Chip members at 85.8 million as of November 2021, an increase of 14.1 million for early 2020.

State Medicaid administrators are now taking steps to do what they can to keep as many of these members as enrolled with some form of health insurance.

Before the pandemic, states reviewed the income, age or disability status of those enrolled to see if they continued to qualify for the state and federal safety net program. This review was suspended during PHE. But state Medicaid officials now face the huge task of reassessing each person’s eligibility. Some state officials may also help those registrants find new jobs, new forms of health insurance, or both, according to Kaiser Health News.

This means that those who got coverage during PHE can’t earn so much that they are no longer eligible for Medicaid. It also means that they must provide whatever information states require to verify income or residency, Kaiser Health News reported.

Those most at risk are Medicaid members who also qualify for Medicare, often referred to as dual eligible. Health Policy Journal Health Affairs Note that these individuals can be disproportionately affected by unnecessary disruptions to Medicaid coverage.

Many Medicaid beneficiaries who received coverage during PHE may be able to enroll in plans through ACA Markets, says Kathryn Hempstead, senior policy advisor to the Robert Wood Johnson Foundation.

“A lot of people may be able to get affordable insurance coverage through the market because Congress has increased tax breaks under the 2021 US Bailout Act,” she adds. Also, some lower-income Medicaid members may qualify for coverage that does not require a premium payment, she says.

However, Hempstead is concerned about Medicaid members who may not be able to afford coverage if the increased credits expire at the end of the year unless Congress extends them. If the tax credits are not renewed, many Medicaid members may be reluctant to purchase health insurance from the market because they will need to pay premiums, she notes.

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