In the third quarter, it will drop to 2.5 percentage points, and in the fourth quarter of 2023, states will receive 1.5 percentage points in additional federal Medicaid funding. CMS guidance about the unwinding of the continuous enrollment provision stresses the importance of conducting outreach to enrollees to update contact information and provides strategies for partnering with other organizations to increase the likelihood that enrollee addresses and phone numbers are up to date. This brief describes 10 key points about the unwinding of the Medicaid continuous enrollment requirement, highlighting data and analyses that can inform the unwinding process as well as recent legislation and guidance issued by the Centers for Medicare and Medicaid Services (CMS) to help states prepare for the end of the continuous enrollment provision. Under the Consolidation Appropriations Act, 2023, the resumption of Medicaid disenrollments is no longer linked to the end of the COVID public health emergency. And if youre no longer eligible for Medicaid, youre almost certainly eligible for an employer-sponsored plan, Medicare, or a subsidized plan in the marketplace. That same analysis revealed that a majority of states provide general information about reasonable modifications and teletypewriter (TTY) numbers on or within one click of their homepage or online application landing page (Figure 8), but fewer states provide information on how to access applications in large print or Braille or how to access American Sign Language interpreters. 3. | Jae C. Hong/AP Photo. Starting April 1, 2023, states can resume Medicaid disenrollments. Enrollees may experience short-term changes in income or circumstances that make them temporarily ineligible. uyx'tE!~YV.v.wDO @:Z98-PtinB*[Elrcr[b8B9NX5IR'[UC.ok"zf3itMAiP((ISh. CMS guidance provides a roadmap for states to streamline processes and implement other strategies to reduce the number of people who lose coverage even though they remain eligible. Some have described this as the single largest enrollment event since the Affordable Care Act. On April 12, 2022, the Secretary of Health and Human Services (HHS), Xavier Becerra, announced the extension of the public health emergency (PHE) related to the Coronavirus Disease 2019 (COVID-19) pandemic. These plans must describe how the state will prioritize renewals, how long the state plans to take to complete the renewals as well as the processes and strategies the state is considering or has adopted to reduce inappropriate coverage loss during the unwinding period. However, waivers that allowed advanced practice registered nurses (APRNs) to practice at the top of their license will expire on October 9 absent further Congressional action. What do these three possible scenarios mean for Medicaid if Congress does not take additional action as proposed in the Build Back Better Act (BBB)? Throughout the COVID-19 public health emergency (PHE), CMS has used a combination of emergency authority waivers, regulations, enforcement discretion, and sub-regulatory guidance to ensure access to care and give health care providers the flexibilities needed to respond to COVID-19 and help keep people safer. As of March 2022, the Medicaid expansion had extended coverage to 8 million low-income adults who would not otherwise have been eligible for Medicaid without it. For a person who is no longer Medicaid-eligible under normal rules, Medicaid coverage can end as early as April 1, 2023. the extra cost that states have incurred to cover the FFCRA-related enrollment growth. That is now expected to happen in May 2023. Even though Congress could still enact some version of the BBB provisions relating to the unwinding of the continuous enrollment requirement, some states would find an April 1, 2022 renewal start date challenging. Can I use my Medicaid coverage in any state? However, if the guardrails are too flimsy or non-existent, states could see a surge in their uninsured populations right as government Covid funding runs dry, and individuals will have to depend on health plans to cover tests, vaccines and therapeutics for the virus. During the COVID-19 national public health emergency that began in March 2020, states have been leaving people on Medicaid. The public health emergency, first declared in January 2020 by the Trump administration, has been renewed every 90 days since the pandemic began. Completing renewals by checking electronic data sources to verify ongoing eligibility reduces the burden on enrollees to maintain coverage. What are your options if youre no longer eligible for Medicaid? The PHE has been in place since January 27, 2020, and renewed throughout the pandemic. What are your coverage options if youre disenrolled from Medicaid? The Biden administration on Friday extended the Covid-19 public health emergency for another three months. Its noteworthy that the additional federal Medicaid funding that states have received is more than double the extra cost that states have incurred to cover the FFCRA-related enrollment growth. Heres what enrollees need to know. Any information we provide is limited to those plans we do offer in your area. This brief provides an overview of the major health-related COVID-19 federal emergency declarations that have been made, and summarizes the flexibilities triggered by each in the following. Update regarding intent to end the national emergency and public health emergency declarations and extensions by way of the Consolidated Appropriations Act (CAA) for Fiscal Year 2023 Update: On Thursday, December 29, 2022, President Biden signed into law H.R. This JAMA Forum discusses the potential ramifications after the COVID-19 public health emergency ends such as limiting telehealth, ending the continuous enrollment requirement in Medicaid, and decreasing regulatory flexibility that has allowed pharmacists to administer COVID-19 vaccines. Omnibus spending bill allows states to resume Medicaid eligibility redeterminations in April. (Be prepared to provide proof of your ongoing eligibility under your states Medicaid rules.). Please provide your zip code to see plans in your area. As the end of the continuous enrollment provision approaches, states can collaborate with health plans and community organizations to conduct outreach to enrollees about the need to complete their annual renewal during the unwinding period. On January 30, the Biden Administration announced May 11, 2023, as the targeted end date for the national public health emergency (PHE) declarations implemented during the COVID-19 pandemic. You can share your story about the impact of the Public Health Emergency HERE. Collectively, these metrics are designed to demonstrate states progress towards restoring timely application processing and initiating and completing renewals of eligibility for all Medicaid and CHIP enrollees and can assist with monitoring the unwinding process to identify problems as they occur. The GOP-led Senate passed the proposal in the 2022 session, but it was killed in the House. Washington Offices and Barbara Jordan Conference Center: 1330 G Street, NW, Washington, DC 20005 | Phone 202-347-5270, www.kff.org | Email Alerts: kff.org/email | facebook.com/KaiserFamilyFoundation | twitter.com/kff. Depending on when such legislation might be taken up, Congress will likely be pressured to push the unwinding out beyond April 1, 2022. But enrollment has trended upward throughout the pandemic, without the normal disenrollments that previously stemmed from the regular Medicaid eligibility redetermination process. 4. If CMS determines a state is out of compliance with any applicable redetermination and reporting requirements, it can require the state to submit a corrective action plan and can require the state to suspend all or some terminations due to procedural reasons until the state takes appropriate corrective action. Key Points. Regardless of timing, the lifting of the continuous enrollment requirement will have a substantial impact on states and Medicaid enrollees, particularly in states that have been unable to renew coverage automatically for a significant portion of enrollees. Were hopeful that states will work to make the redeterminations and renewals process as transparent, accurate, and simple as possible. The COVID public health emergency (PHE) is expected to be extended again in January 2023, but the omnibus bill de-links the resumption of Medicaid eligibility redeterminations from the PHE, and allows states to start processing eligibility determinations as of April 1, 2023. CMS guidance also outlines specific steps states can take, including ensuring accessibility of forms and notices for people with LEP and people with disabilities and reviewing communications strategies to ensure accessibility of information. Much of Medicare is in statute, and as a result the Administration has limited authority to expand telehealth absent Congressional action. How many people will lose Medicaid coverage when the continuous coverage requirement ends? The COVID-19 pandemic cast a spotlight on the importance of the various safety net systems that the U.S. has in place. Herstate health exchange updatesare regularly cited by media who cover health reform and by other health insurance experts. Some of these waivers had previously expired, but ANA is still advocating to change the law and make them permanently part of the Medicare program. The Centers for Medicare & Medicaid Services (CMS) implemented several interim final rules during the PHE. Thats because Medicaid and CHIP eligibility for children extend to significantly higher income ranges, and marketplace subsidies are never available if a person is eligible for Medicaid or CHIP. What does this mean for Medicaid? With respect to Medicare: We do not offer every plan available in your area. (Prior to the pandemic, states had to recheck each enrollees eligibility at least once per year, and disenroll people who were no longer eligible. Filling the need for trusted information on national health issues, Jennifer Tolbert and CMS is releasing the 2022-2023 Medicaid Managed Care Rate Development Guide for states to use when setting rates with respect to any managed care program subject to federal actuarial soundness requirements during rating periods starting between July 1, 2022 and June 30, 2023. 7.8 million enrollees by March 2023. Without other action, states can start disenrolling people beginning May 1, 2022. Would love your thoughts, please comment. For example, California and Rhode Island are planning to automatically enroll some people who lose Medicaid eligibility into a marketplace plan in their area (although they would still have the normal 60-day window to select a different plan or opt-out if they dont want marketplace coverage). People who can't access the website or who . endstream endobj startxref US Department of Health and Human Services Secretary Xavier Becerra . forced a handful of successful Senate votes. While the PHE ends on May 11, in payments rules CMS has extended the waivers for an additional 152 days to allow providers time to undo the waivers. Findings This cohort study of 4869 Latina patients with gestational (n = 2907) or preexisting diabetes (n . While nearly all states accept information by mail and in person, slightly fewer provide options for individuals to submit information over the phone (39 states) or through online accounts (41 states). hbbd``b`$ = $: " Ms ]@B#F_ E+ Earlier today, HHS Secretary Becerra renewed the COVID-related public health emergency (PHE). Another analysis examining a cohort of children newly enrolled in Medicaid in July 2017 found that churn rates more than doubled following annual renewal, signaling that many eligible children lose coverage at renewal. Were providing certainty to states and giving them a gradual stream of funding and guardrail requirements that protect people. But the Consolidated Appropriations Act, 2023 ensures that states continue to receive at least some additional federal Medicaid funding throughout 2023. By law, public health emergencies are declared in 90-day increments. This increase is in large part due to the extension of the COVID-19 pandemic public health emergency (PHE).2 Due to the maintenance of effort requirements under the Families First Coronavirus Response Act (FFCRA), which has precluded most forms of involuntary disenrollment from The Biden administration appears headed toward extending the COVID-19 public health emergency for another three months, allowing special powers and programs to continue past the midterm election. instructed providers requesting an extension to specify, as part of their extension request, their plan for finishing their demonstrations of compliance by December 30, 2022. Some people who will lose Medicaid eligibility are now eligible for Medicare instead. Because of specific Congressional action many of the telehealth flexibilities authorized under the PHE will continue through the end of 2024. However, in many states, the share of renewals completed on an ex parte basis is low. Driving the news: HHS had extended the emergency declaration through Oct. 13 and pledged it would give states and health providers 60 days' notice . Republicans pushing for the deal have also been reminding Democrats that their original Build Back Better legislative package which ultimately became the Inflation Reduction Act and passed this year after being significantly whittled down included a wind-down of the public health emergency as a pay-for. The Congressional Budget Office assumes the public health emergency for Covid will expire in July barring another extension by the Biden administration. This additional match will be slowly wound down through 2023 and the federal match will be returned to what it had been prior to the PHE in January 2024. CMS is referring to the return to normal eligibility redeterminations and disenrollments as a Medicaid and CHIP unwinding.. The new rules give states a clear time frame: They can begin to initiate the renewal/redetermination process as early as February 1, 2023 (states can start this in February, March, or April), and disenrollments can be effective as early as April 1, 2023 if adequate notice is given to the enrollee. Find out how much financial help you may qualify for. The resumption of eligibility redeterminations is no longer linked to end of public health emergency. In some states, it will be the most significant enrollment action in the 50+ year history of Medicaid. Published: Feb 22, 2023. One note about the Childrens Health Insurance Program (CHIP): States that operate a separate CHIP were not required to suspend CHIP disenrollments during the pandemic. The Biden administration extended the U.S. coronavirus public health emergency, now more than two years old, for another 90 days on Wednesday. Doing so would decrease federal spending on Medicaid and allow states to remove ineligible people from the program, saving the government tens of billions of dollars. As part of a Covid-19 relief package passed in March 2020, states were barred from kicking people off Medicaid during the public health emergency in exchange for additional federal matching funds. including education, public health, justice, environment, equity, and, . HHS projects that nearly 8% of current Medicaid enrollees will lose their coverage despite continuing to be eligible once eligibility redeterminations resume. Other than that, if you miss the special enrollment period for your particular coverage, youll have to wait until the next annual open enrollment period to sign up for coverage (employers set their own annual enrollment windows; Medicares general enrollment period is January March each year). 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