By skyforbes 
When the COVID-19 pandemic sent our health care system reeling and forced many of us to adapt amid a public health crisis, Congress acted and passed the Families First Coronavirus Response Act to protect many of our country’s most vulnerable. This included the Medicaid continuous enrollment provision, which effectively required states to keep all Medicaid enrollees covered by Medicaid regardless of changes in their eligibility status — allowing people to focus on staying safe amid the pandemic, and not whether they would be covered when they needed health care. Medicaid kept more than 80 million people covered and cared for during the pandemic, but as the public health emergency came to a close, so too did the continuous enrollment provision.
With this provision gone, states were tasked with “redetermining” the eligibility of their residents covered by Medicaid. While the requirements are different across the states, one thing is true — unless states remain committed to thoroughly checking peoples’ enrollment status, tens of millions of people are expected to lose their Medicaid coverage due to the redetermination process.
Lessons from the States: How We Can Prioritize Keeping People Covered
To be clear, the way some states are handling Medicaid redetermination is injecting uncertainty into our health care system. While many people have been able to count on their coverage for several years, they are now finding themselves navigating an often complex and confusing process to determine their eligibility for the same Medicaid coverage. Amid all of the chaos, there are some lessons that can be learned from states managing the process responsibly.
Leading the pack is the state of Oregon. Earlier last year, the Oregon legislature authorized the creation of a Basic Health Plan (BHP). This BHP, known as the Bridge Plan, is designed to provide affordable, dependable quality health insurance to people making too much to qualify for Medicaid, but not enough to afford private insurance outside of an employer. Because the Bridge Plan offers coverage to Oregonians with incomes between Medicaid and marketplace limits, it is expected to reduce the “churn” between the two coverage options and give people coverage they can depend on regardless of fluctuations in their income.
As Oregon prepares for the Bridge Plan’s launch next year, the state amended its Medicaid waiver to keep people who would otherwise qualify for the Bridge Plan covered under Medicaid while they complete eligibility determinations. In other words, instead of kicking people off of Medicaid and forcing them to wait for the Bridge Plan to become available, Oregon is streamlining the process and prioritizing people by working to extend their Medicaid coverage while the state prepares to launch another affordable option. This approach is one that other states can learn from — while millions of people will lose their Medicaid coverage through the redetermination process, Oregon is taking actionable steps to ensure that those losing their coverage have quality, affordable options.
While the state of New York struggled with Medicaid redetermination at the start — with the rate of disenrollments quickly outpacing other states — it has recovered and has quietly moved from concerning to encouraging in recent months. This recovery provides many clues to other states struggling to responsibly redetermine the eligibility of people covered by Medicaid. Early in the process, New York was experiencing a high number of “procedural” disenrollments, when people lose their Medicaid not because of ineligibility, but because of incomplete paperwork, lack of information about the need to re-enroll, administrative mistakes, or any reason not related to eligibility. The state quickly responded by making the process easier to navigate and stepping up its outreach efforts to hard-to-reach communities who may not know their coverage was at risk. As a result, New York’s rate of disenrollments has slowed significantly — and 68,000 people have had their coverage reinstated.
While Oregon and New York stand out in managing this process responsibly and learning from earlier mistakes, success is not limited to these two states. California’s marketplace is reaching out directly to those no longer eligible for Medicaid to inform them of their other coverage options, while Nevada is also reinstating coverage for those still eligible for Medicaid whose coverage was terminated for procedural reasons. Maine’s health department is partnering with community organizations to help individuals complete the renewal process and find alternative coverage, while Idaho is opening a special enrollment period on its state-based exchange for people who are losing Medicaid coverage. Nationwide, the Centers for Medicare & Medicaid Services (CMS) is working with states to identify instances where people erroneously lost coverage and has worked with states to reinstate coverage for nearly 500,000 children and other people.
Our Take
States have a responsibility to handle this process with a focus on keeping people covered — we know from our listening work that anxieties about losing health care coverage and not being able to afford health care are top of mind for people. There is still a lot of work to be done, and with a large majority of disenrollments across the nation still being procedural, even the best performing states have room for improvement.
By reducing procedural disenrollments and keeping people informed of the need to re-enroll while also connecting them to other affordable coverage options, states can navigate redetermination responsibly. Additionally, states that haven’t yet expanded Medicaid or extended postpartum Medicaid coverage to 12 months should take action to do so, allowing more people to keep the Medicaid coverage they’ve come to rely on. Through these solutions, we can ideally keep as many people covered as possible — and allow millions of people to breathe a sigh of relief that their health care will be there when they need it.
Eric Waskowicz is our Policy Manager.
Kelsey Wulfkuhle is our State External Affairs Manager.
About United States of Care:
United States of Care is a nonpartisan organization committed to ensuring that everyone has access to quality, affordable health care.
Disclaimer:
This article is part of United States of Care’s Medium publication, representing the individual views of the author(s). It does not necessarily reflect the beliefs or positions held organizationally by United States of Care or its board of directors. As a non-profit organization dedicated to ensuring that everyone has access to quality, affordable health care, United States of Care values and seeks out a diverse range of perspectives. We believe in the power of different voices to enhance understanding, empathy, and dialogue about critical health care issues.
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