Medicaid stakeholders warn of hurdles for redeterminations process

 

• A group of stakeholders aired their concerns over Medicaid redeterminations, which will begin once the COVID-19 public health emergency is over, before the influential advisory panel that guides Congress on issues facing the Medicaid program.
• Last week, stakeholders told the Medicaid and Children's Health Insurance Program Payment and Access Commission that a chief concern is unnecessarily interrupting coverage for the vulnerable population.
• They're also worried about having enough advance notice and time to process through the applications after Medicaid rolls have swelled considerably during the public health emergency.

The fallout from the pandemic caused record unemployment, which stoked fears of insurance coverage losses at a time when people needed it most: during a deadly pandemic. To ease these concerns, lawmakers paused eligibility determinations in the Medicaid program to ensure continuous coverage. Knowing it would place an additional financial burden on states, lawmakers allotted a more favorable match rate to help states insure these members. 

However, once the COVID-19 public health emergency ends, which the industry expects to happen this year, states can restart checking whether members are still eligible for coverage. While that sounds easy, stakeholders caution it's much more nuanced and not as simple as flipping a switch. 

"The stakes for getting this right are high," Melissa McChesney, health policy adviser at UnidosUS, a Latino civil rights and advocacy organization, said. McChesney warned that poor planning could trigger massive enrollment losses for eligible people. McChesney said a bungled process could deepen existing racial and ethnic disparities. 

One of the main concerns is ample time to restart this process as state agencies will likely need to make contact with members again. Panelists noted many addresses are outdated, posing a risk to continuous enrollment. 

"My first concern is: Will we really get the 12 months?" Jeff Nelson, bureau director of eligibility policy for Utah Department of Health, asked the commission. He's worried that still may not be enough time to complete the process. Previous guidance CMS has indicated states may take up to 12 months to complete the process. 

For starters, his staff needs more training. Newer staffers have never processed a Medicaid or CHIP renewal. "They don't know what this even means as we go to unwind. We've got a fifth of the workforce that potentially doesn't know what they're doing. That's going to be a problem for us," Nelson said.

Nelson is also concerned about getting enough advance warning about when the public health emergency will end, which will trigger the process of redeterminations. Given a greater lead time, there are tasks he can begin to prioritize and plan for. 

MACPAC commissioners were impressed with the panelists and seemed sympathetic to their concerns, but acknowledged in discussions following the presentation that there was likely no action yet to take. They want, however to keep a pulse on the developments. 

The redeterminations could result in a fluctuation in the nation's payer mix, which saw Medicaid rolls balloon over the course of the pandemic.

Enrollment in Medicaid and CHIP hit 83.2 million members in June 2021, a 18% increase from February 2020, according to enrollment data from CMS. 

Managed care firms are also bracing for Medicaid rolls to decline as members roll off due to redeterminations. Companies like Molina and Centene that have a heavy focus on government-sponsored programs reported increases in membership thanks to the redetermination pause. A broad swath of Medicaid enrollees are covered by private plans that contract with states to provide benefits to their eligible residents.

https://www.healthcaredive.com/news/macpac-hears-concerns-over-medicaid-redeterminations/617545/