Millions could lose Medicaid coverage when the PHE ends

Early in the COVID-19 crisis, states paused Medicaid disenrollments to help keep people from losing health coverage during the pandemic. Now, state Medicaid programs are gearing up to restart disenrollments after this COVID hiatus, and millions of people could lose coverage, including children and adults who remain eligible but get dropped from the rolls because of missed mailings or other administrative glitches. OT practitioners can help minimize coverage losses by encouraging clients who rely on Medicaid to make sure their contact information is up to date and to watch for and respond quickly to correspondence from state agencies about their health insurance.

Unwinding the continuous enrollment requirement

The Families First Coronavirus Relief Act offered states a 6.2% increase in the federal portion of Medicaid funding on the condition that they keep people continuously enrolled through the COVID-19 public health emergency (PHE). Medicaid enrollment has increased nearly 25% since the start of the pandemic, with 80 million people now covered by the state-federal health program. States are preparing to return to normal operations after the PHE ends, which will require them to conduct eligibility redeterminations for all Medicaid enrollees and remove those who no longer qualify, a process health policy experts are calling “unwinding.”

Some states will space the work out over 14 months, the maximum time allowed, while others may try to process the redeterminations as quickly as possible. State-level decisions will determine how many people are able to maintain coverage: while many people will no longer be eligible, many others could be wrongfully terminated because the state Medicaid agency can’t reach them, or they simply fall through the cracks of a rushed process. KFF estimates that between 5.3 million and 14.2 million people could be disenrolled, depending on how states handle the unwinding.

The PHE currently extends through July 15, 2022, although many expect it to be extended for an additional 90-day increment through mid-October. The Biden administration has committed to giving states at least 60 days’ notice before ending the PHE.

Minimizing coverage gaps

OT practitioners can help prevent interruptions in care by encouraging people who rely on Medicaid to take these steps:

Right now:

• Update your contact information. Make sure the state Medicaid agency knows your current mailing address, phone number, and e-mail so they can contact you with important information about your coverage.

When the end of the PHE is announced:

• Get ready to renew your coverage. Medicaid will be restarting regular eligibility checks soon. Be on the lookout for letters, e-mails, calls, or text messages from Medicaid, and respond quickly to requests for information.
• Be prepared to transition to another source of coverage if you’re no longer eligible. You may be able to get affordable health insurance from your state’s Affordable Care Act (ACA) Marketplace. Kids may be able to move to Children’s Health Insurance Program (CHIP) coverage.

Some states have posted announcements and toolkits on their Medicaid provider websites with information about the unwinding, like how to update contact information or connect with the Marketplace.