As the U.S. winds down temporary public health measures implemented as a response to the COVID-19 pandemic, the ending of the public health emergency declaration could kick up to 16 million people off of Medicaid, a program that provides healthcare services to low-income individuals and families.
Before the pandemic, approximately 71 million Americans were enrolled in Medicaid and the Children’s Health Insurance Program (CHIP). This number grew to 85 million by September 2021, a nearly 20% increase in less than two years. During the pandemic, Congress boosted Medicaid spending while simultaneously blocking states from involuntarily unenrolling people due to changes in eligibility status. The combined efforts enabled millions of Americans to retain access to health care services throughout the pandemic.
With infections, hospitalizations, and deaths all on a downward trend, public health organizations are looking to wind down these temporary measures. Meanwhile, state and federal officials are working to ensure that those still eligible for Medicaid coverage retain it, and those that are no longer eligible are handed off to alternatives, which are likely to be employer-sponsored or healthcare marketplace plans.
Further guidance is being issued to states surrounding renewals of eligibility. The Centers for Medicare and Medicaid Services (CMS) are implementing an extended deadline for processing eligibility renewals from 12 to 14 months following the end of the public health emergency. They are also urging states to limit renewals to less than one-ninth of their caseload in a given month, and recommending the adoption of a risk-based approach centered on preventing inappropriate terminations and easing the transitions to other plans for those no longer eligible.
States are required to start renewals with an “ex parte” process first. They must draw from available data, such as from the Supplemental Nutritional Assistance Program or the Women, Infants, and Children program, to determine eligibility, with a target of 60 to 70% of renewals occurring without any action required by the beneficiary. Given the vast changes in life circumstances over the past two years for many Americans, recipients who must verify their eligibility by mailing in documentation are more likely to be left without benefits unexpectedly.
While the public health emergency declaration has enabled millions of Americans living in poverty to retain access to healthcare during the pandemic, a sudden end to benefits is sure to have a profound effect on the health of the public. Careful planning will be needed to ensure ongoing care and a smooth transition out of the Medicaid system.
