Government health agencies, while continuing to monitor COVID-19 trends, have begun planning for the end of the public health emergency. As previously reported, the U.S. Department of Health and Human Services has for two years kept in place an official determination that COVID-19 constitutes a national public health emergency. While the PHE declaration remains in effect, extra federal funding flows to state Medicaid programs – and, so long as the states accept that enhanced funding, they cannot disenroll existing beneficiaries from their Medicaid programs. Thanks in large part to the pause in Medicaid eligibility determinations, Medicaid/CHIP enrollment has grown by 12.5 million nationwide since the start of the pandemic.
But when the PHE ends, Medicaid eligibility reviews and terminations will resume. This will pose a challenge for state agencies and, crucially, for Medicaid enrollees. The Urban Institute estimates that up to 16 million people may be at risk of losing their Medicaid coverage in the coming “unwinding.” Some will lose coverage because they are no longer eligible: e.g., their income is too high, or (for those living in a non-expansion state) they or their children have aged out of Medicaid eligibility. Other individuals, though, risk losing coverage because of red tape or procedural reasons. Their contact information may be out-of-date, or they may face challenges in navigating bureaucratic processes, language barriers, and the like.
On March 3rd, the federal Centers for Medicare and Medicaid Services (CMS) issued guidance and tools for state Medicaid directors about how to meet these challenges. The guidance prioritizes promoting continuity of coverage. It reminds state agencies to follow procedures designed to minimize the risk of wrongful terminations. To that end, the Administration will allow states an extra two months to process renewals, up to 14 months after the end of the PHE, and it strongly encourages them to take a phased approach (initiating no more than 1/9th of their total caseload each month). The guidance also encourages states to assist the transition to Marketplace coverage for individuals who are no longer eligible for Medicaid.
Because gaps in care can be devastating for people with bleeding disorders, HFA supports robust efforts to keep people connected to coverage. HFA and coalition allies have written to 50 state Medicaid directors about their plans for resuming Medicaid renewals. It’s still uncertain when the PHE will end,[1] but HFA will shortly begin outreach efforts reminding community members with Medicaid and CHIP coverage to update their contact information, and to be on the lookout for any letters from their health program that ask them to complete renewal forms.
Quick Hits
- On Tuesday, March 15, President Biden signed into law Congress’s $1.5 trillion omnibus spending bill, which funds the federal government through September. Among (many) other things, the legislation: extends Medicare coverage of telehealth visits for 151 days past the end of the PHE; provides a temporary increase in federal Medicaid funding for Puerto Rico; and establishes a new biomedical research agency (ARPA-H, the Advanced Research Projects Agency for Health).
- Less than two weeks later (March 28), the Biden Administration submitted its 2023 budget request to Congress, including a substantial boost to HHS funding. In the budget submission, the Administration reiterated its commitment to strengthen the ACA Marketplaces and ensure that all Americans have access to high-quality, affordable health insurance (a commitment also expressed in President Biden’s March 1 State of the Union address).
- Lower-income consumers (earning at or below 150% of the Federal Poverty Level) can now enroll in affordable Marketplace coverage at any time, even if they missed the Open Enrollment Period. This new Special Enrollment opportunity is now available via healthcare.gov and in most states that operate their own state-based exchanges.
- HHS marked the 12th anniversary of the Affordable Care Act’s passage on March 23rd with the issuance of a final Marketplace open enrollment report for 2022. The report noted that overall enrollment for 2022 exceeded the prior year’s enrollment by 21 percent, reaching a record high of 14.5 million people. These figures underscore the impact of enhanced ACA premium subsidies (boosted by the 2021 American Rescue Plan Act) – and the need to extend those subsidies into 2023 and beyond.
- HFA staff were pleased once again to participate in NHF’s Washington Days meetings, asking lawmakers to support federal funding for hemophilia programs, and to champion R. 5801 (protecting patients from copay accumulator adjusters). As of March 30, H.R. 5801 has 26 cosponsors. You can still quickly and easily advocate for the bill by filling out this form.
- Washington State Governor Jay Inslee signed into law SB 5610, a bill protecting patients from copay accumulator adjuster protections on March 30th. Congratulations to the Bleeding Disorder Foundation of Washington and all the grassroots advocates who worked for enactment of this law! In other positive news, the Ohio House unanimously passed a similar bill, HB 135. That measure now moves to the Ohio Senate for consideration.
[1] In mid-December, the Biden Administration promised to give states at least 60 days’ notice before sunsetting the PHE. The current PHE declaration expires in mid-April 2022 but – given the Administration’s pledge to state agencies – all stakeholders expect that the PHE declaration will again be renewed, at least into the summer.
