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Press Release

Disclosures: Buettgens and Green are employees at the Urban Institute. Hempstead is an employee at the Robert Wood Johnson Foundation. Healio could not confirm other relevant financial disclosures at the time of publication.
March 16, 2022
4 min read
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16 million people may lose Medicaid coverage when public health emergency ends

Source:

Press Release

Disclosures: Buettgens and Green are employees at the Urban Institute. Hempstead is an employee at the Robert Wood Johnson Foundation. Healio could not confirm other relevant financial disclosures at the time of publication.
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Almost 16 million Americans who enrolled in Medicaid during the public health emergency could lose coverage when the emergency declaration ends, data show.

The findings are from a report by the Urban Institute with support from the Robert Wood Johnson Foundation. The Urban Institute previously estimated that about 15 million Americans could lose coverage when the emergency declaration ends, Healio reported.

Proportion of Americans who may lose Medicaid coverage in 2023 based on the expiration date of the public health emergency in 2022
What will happen to Medicaid enrollees’ health coverage after the public health emergency https://www.rwjf.org/content/dam/farm/reports/issue_briefs/2022/rwjf468119. Published March 15, 2022. Accessed March 16, 2022.

In their latest report, researchers made several projections of coverage losses in 2023 based on when the emergency declaration might expire.

“Just as coverage is critically important for health and financial well-being of individuals and communities, the loss of coverage will be harmful, particularly for people who are undergoing treatment or have chronic health problems that need to be managed,” Katherine Hempstead, PhD, a senior policy adviser at the Robert Wood Johnson Foundation, told Healio. “There is a solid public health rationale for continuous coverage. For example, in the context of an infectious disease, we want to eliminate barriers to seeking care since everyone’s health is interconnected. To the extent to which we see increased COVID-19 case rates, which should not surprise us given news from other countries and trends in wastewater surveillance in the U.S., disadvantages of uninsurance from a public health perspective would be very obvious.”

 
Matthew Buettgens
Matthew Buettgens

New projections

Matthew Buettgens, PhD, a senior fellow in the Health Policy Center at the Urban Institute, and Andrew Green, MSDSPP, a research analyst in the Health Policy Center at the Urban Institute, used the latest available data from each state to assess monthly enrollment increases compared with prepandemic enrollment.

According to the findings, if the emergency declaration had expired after the first quarter of 2022, 12.9 million Americans could have lost coverage. Meanwhile, expiration after the second quarter could result in a loss of coverage for 14.4 million Americans, and expiration after the third quarter could result in a loss of coverage for 15.8 million Americans.

The longer the emergency declaration lasts, the greater the potential number of people losing Medicaid coverage, according to Buettgens and Green. In February, the Biden administration announced a continuation of the national emergency declaration, stating that it will “continue in effect beyond March 1, 2022.” No projected end date has been announced.

Federal government spending on Medicaid in 2022 and 2023 would be $34 billion (4.3%) higher if the emergency declaration were extended for one additional quarter and $70.5 (8.9%) billion higher if it were extended for two quarters. Also, state government spending in 2022 and 2023 would increase by $5 billion (1.2%) or $10.9 (2.7%) billion depending on the emergency extension.

“The data demonstrate the importance of minimizing inappropriate Medicaid disenrollment and helping those losing Medicaid coverage to enroll in Marketplace coverage,” Buettgens said in a press release. “As families continue to face health and economic consequences of the ongoing pandemic, large-scale, rapid Medicaid disenrollment could have serious effects on the well-being of millions of people.”

Most of the new Medicaid enrollment seen during the pandemic was from the continuous coverage requirement mandated by the Families First Coronavirus Response Act. This legislation prohibited state Medicaid agencies from disenrolling beneficiaries during the public health emergency.

The researchers reported that people losing Medicaid coverage risk becoming uninsured. While many people would be eligible for insurance coverage through the Children’s Health Insurance Program (CHIP) or the Marketplace, not everyone would enroll since these plans may be more costly than Medicaid.

Of the children losing Medicaid, 57% would be eligible for CHIP and an additional 9% would be eligible for Marketplace coverage with tax credits, according to the report.

“Good coordination between Marketplaces and Medicaid agencies is essential to reduce inappropriate losses of health coverage,” Buettgens and Green wrote.

Ending Medicaid continuous enrollment

The Kaiser Family Foundation (KFF) recently released a separate report about how states are planning for the end of the continuous enrollment requirement. The requirement increased Medicaid and CHIP enrollment by 19.1% since the start of the pandemic, according to the KFF.

“The state role will be critical,” Hempstead said. “It is essential to do everything possible to get updated contact information, engage in proactive outreach and assist in transitions.”

According to survey results from January 2022, 27 states in the U.S. reported that they have a plan for how to prioritize outstanding eligibility and renewal actions once the enrollment requirement is lifted.

Currently, CMS allows up to 12 months to initiate and 14 months to complete all redeterminations. The KFF reported that 40 states plan on taking 9 to 12 months to process redeterminations; four states plan on taking 6 to 9 months; and four states plan on taking 3 to 6 months.

Despite guidance released by CMS, “key policy choices as well as the implementation strategies about approaches to unwinding will vary across the states, and these choices will have major implications for Medicaid enrollment and broader coverage,” Robin Rudowitz, MPA, the vice president of KFF and the director for the program on Medicaid and the uninsured, said during a webinar presentation about the report.

To prepare for redeterminations and to avoid large losses of coverage, 41 states plan on voluntarily following up with enrollees when they are at risk for a coverage loss; 46 states are working on updating enrollees’ mailing addresses; and 30 states plan on boosting their staff capacity by approving overtime and hiring new workers.

“Millions of people could lose coverage if those who continue to be eligible for Medicaid are disenrolled for procedural reasons,” Tricia Brooks, MBA, a research professor in the center for children and families at the Georgetown University McCourt School of Public Policy, said during the webinar.

References:

Notice on the continuation of the national emergency concerning the coronavirus disease 2019 (COVID-19) pandemic. https://www.whitehouse.gov/briefing-room/presidential-actions/2022/02/18/notice-on-the-continuation-of-the-national-emergency-concerning-the-coronavirus-disease-2019-covid-19-pandemic-2/. Published Feb. 18, 2022. Accessed March 16, 2022.

States are planning for the end of the continuous enrollment requirement in Medicaid after the COVID-19 public health emergency expires, but many have not made key decisions. https://www.kff.org/medicaid/press-release/states-are-planning-for-the-end-of-the-continuous-enrollment-requirement-in-medicaid-after-the-covid-19-public-health-emergency-expires-but-many-have-not-made-key-decisions/. Published March 16, 2022. Accessed March 16, 2022.

What will happen to Medicaid enrollees’ health coverage after the public health emergency? https://www.rwjf.org/content/dam/farm/reports/issue_briefs/2022/rwjf468119. Published March 15, 2022. Accessed March 16, 2022.