The Approaching Medicaid Cliff

The Issue:

The COVID pandemic resulted in a 30% increase (19.5M people) in the number of Americans covered by Medicaid. The federal government supported states during that time by providing billions of dollars in additional Medicaid funding. However, it did so under the condition that states not disenroll any recipients for the duration of the Public Health Emergency. President Biden recently announced the pending end of the PHE, which has significant implications for Medicaid-covered individuals.

What You Need to Know:

Beginning in April, states will once again be able to revalidate individuals’ Medicaid eligibility. If your patients currently covered by Medicaid either (a) no longer meet eligibility requirements or (b) do not respond to the revalidation requests, they will be disenrolled and could fall into the ranks of the uninsured. The Biden Administration estimates that 17% of Medicaid recipients (15M people) could lose coverage, with nearly half being dropped for purely technical reasons, such as failing to respond to requests for updated personal information.

What This Means for You:

First, to ensure that your current Medicaid patients remain insured, you should immediately begin outreach to educate them about the importance of updating their contact info if they have moved in the last three years. Many states have already created resources to educate enrollees about how to update their contact info. One quick and useful way to locate those resources for your state is to enter the following terms into your search engine: “[your state] Medicaid unwinding.”

Second, make sure Medicaid recipients understand the importance of responding promptly to requests from your state’s Medicaid program. If they fail to answer information requests, they will get disenrolled, creating a coverage gap that will prevent them from receiving continuous care from you.

For those that are disenrolled from Medicaid, there will be an opportunity for them to obtain coverage through the Affordable Care Act marketplaces. If you are in one of the 30 states covered by the federal marketplace, individuals will have until July 31, 2024 to sign up for ACA coverage. In the remaining 20 states, the specific timing of open enrollment will likely vary.

The Medicaid population presents unique challenges, as individuals enrolled in this program may be less likely to have a stable home address, access to internet services, and/or speak English as a second language. It is therefore critical to initiate this process immediately to ensure your patients have the resources they need to stay enrolled and so that you can continue to treat them after the PHE ends.