Self-made wound: the impending loss of coverage

President Biden recently said that The epidemic is over. “No matter how you feel about this statement or explain itIt is clear that state and federal health policy has been, and continues to be, moving in the direction of behave as if The epidemic is already over. However, the big boot that hasn’t been dropped looms large — millions of Americans are on the verge of losing their Medicaid coverage, although many will still qualify. This amounts to the self-inflicted wound of loss of coverage and a potential crisis in accessing health care, simply because of paperwork.

that August report From HHS that about 15 million Americans will lose Medicaid or Children’s Health Insurance Program (CHIP) coverage once COVID-19 is declared a federal public health emergency (PHE) Expiry allowed. Of those 15 million, 8.2 million are expected to no longer qualify for Medicaid or CHIP — but nearly (6.8 million) will become uninsured despite being eligible.

Why does this happen?

This “slope” from Medicaid will happen because the additional funding states have received under the First Families Coronavirus Response Act (FFCRA) since March 2020 has been conditional. Keep everyone registered By stopping all the bureaucracy that determines whether people are still eligible. Once all re-eligibility processes resume, the lack of up-to-date contact information, documentation requests and other administrative burdens will leave many people falling through the loopholes. a wrong addressAnd the I missed one messageAnd everything starts to collapse. This will be tolerated devastating effects for health.

When will this happen?

HHS said it will provide 60 days notice to states prior to any termination or expiration of PHE – and they have not yet done so. It also seems incredibly unlikely that they will announce an end date for PHE before the midterms, as that would be a major political wound. So, it’s possible we’ll be safe until at least January 2023 – but the extensions beyond that seem less certain.

What are countries doing to prepare?

CMS has issued a large number of guidelines over the past year for Helping countries prepare for the end of PHE and reduce frothAnother word for when people lose coverage. some of this guidance It has included ways to work with managed care plans, which deliver benefits more than 70% From Medicaid registrants, for updated beneficiary contact information, ways to conduct outreach and provide support to registrants during the redetermination process.

However, the end of the PHE and Medicaid re-establishment process will be largely a Country-by-country story. Georgetown University Center for Children and Families tracking How countries prepare for the dismantling process. Unsurprisingly, there is great disparity between states’ plans, outreach efforts, and the types of information available to people looking to renew their coverage. For example, less than half of the states have a publicly available plan for how the redefinition will occur. While CMS has encouraged countries to develop plans, they are not required To submit their plans to the CMS and there is no general reporting requirement.

Who will suffer more?

If you look in the HHS report, you’ll see that the deregistration ramp is likely a file A disaster for health justice – as if to the pandemic itself was not enough. a The majority of Non-white and/or Hispanic people expected to lose coverage make up 52% ​​of those who lost coverage due to changes in eligibility and 61% among those who lost coverage due to administrative burdens. Only 17% of non-Hispanic whites are projected to be inappropriately deregistered, compared to 40% of non-Hispanic blacks, 51% of Asian Americans, Native Hawaiians, and Pacific Islanders, and 64% of Hispanics—a pretty grim picture. This represents a disproportionate burden of loss of coverage, when it is still eligible, among those already incurring unfair burdens for the epidemic and systematic racism generally.

Other key populations at risk are older adults and people with disabilities who have Medicaid coverage, or those who are not part of the adjusted gross income (MAGI) population. Under the Affordable Care Act, states are required to re-establish eligibility upon renewal using available data. This process, known as One-sided renewal, prevents registrants from responding to cumbersome re-registration notices and forms, possibly missing them. Despite federal requirements, not all states attempt unilateral renewals for seniors and people with disabilities who have Medicaid coverage, or those who do not qualify based on income. The unilateral exclusion of these groups from the process has important health equity implications, making already vulnerable groups more vulnerable and at risk of inappropriately ending their coverage.

What can he do?

There are ways to mitigate some of the loss of coverage and ensure that people continue to have access to care. HHS recently released a file Suggested rule This would simplify Medicaid application by shifting more of the burden of application and renewals to the government rather than those trying to enroll or renew their coverage. We can also change the rules to allow countries to do so Use more data, such as information collected to check eligibility for the Supplemental Nutrition Assistance Program (SNAP), in making renewal decisions, rather than relying too much on income. Biden administration too He made a big investment in shipping establishments, which can help those who are no longer eligible to transition to Medicaid to market coverage. Furthermore, states should use this as an opportunity to identify the most effective ways to reach Medicaid enrollees Partnership with researchers To test different communication methods surrounding renovations and re-definitions.

As the federal government and state Medicaid agencies continue to prepare for the end of PHE, it is critical that they consider who these stressful processes will impact the most and how to improve them to prevent people from falling through the cracks. More sick Americans not getting care is the last thing we need.

Paul Schaeffer, Ph.D., Assistant Professor in the Department of Health Law, Policy, and Administration at Boston University. Gabriella Abu Alaia He is an MPP candidate at Harvard University.


The search for this piece was supported by Arnold Ventures. Schaeffer has received research funding over the past 12 months from the Robert Wood Johnson Foundation, the Commonwealth Fund, Arnold Ventures and Renova Health. He is also an investigator for the VA Boston Healthcare System under contract with the Boston University School of Public Health.

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