Word from Washington: June 2023

Medicaid disenrollments are now underway in about 40 states, as part of the Medicaid “unwinding.” Medicaid unwinding, recall, is shorthand for the resumption of regular Medicaid eligibility reviews and terminations, following a three-year pause during the COVID public health emergency.  

Unfortunately, early reports from 26 states show that at more than 1.5 million Medicaid beneficiaries have been disenrolled as of June 27, 2023. (Because not all states report data, this figure undercounts the actual number of disenrollments.) Disenrollment rates vary across reporting states, ranging from 81% in South Carolina to 16% in Virginia. Of particular concern, data across all states show that very high numbers of people are losing coverage for “procedural” reasons – paperwork – despite potentially remaining eligible. 

U.S. Secretary of Health and Human Services Xavier Becerra has expressed deep concern with the high rates of procedural disenrollments, “especially those who appear to have lost coverage for avoidable reasons that state Medicaid offices have the power to prevent or mitigate.” HHS has urged states to tap the brakes, outlining additional steps that states can take to mitigate procedural losses: partnering in outreach with Medicaid managed care plans; cross-checking for eligibility against other safety net programs; and teaming with schools, pharmacies, faith-based groups, and other community organizations. 

HHS has launched an “all-hands-on-deck” effort to reach people who may be affected by the Medicaid unwinding. HFA will continue to provide information and outreach as we seek to protect health coverage for members of the bleeding disorders community. 

Quick Hits: 

  • CMS published new resources (English and Spanish language versions) explaining consumer protections against unexpected out-of-network medical bills. The federal No Surprises Act protects people from unexpected bills for (a) out-of-network emergency room care, (b) non-emergency care received at an in-network facility, and (c) air ambulance services.   
  • The U.S. Supreme Court (Health and Hospital Corporation of Marion County, Indiana v. Talevski) ruled that individuals can sue under the federal civil rights statute to enforce their rights under the Medicaid program. Patient advocates including HFA had filed an amicus brief in the case and applauded the Court’s ruling. 
  • HFA joined with 15 patient groups in another amicus brief in Braidwood Management v. Becerra, litigation defending consumers’ rights to no-cost, evidence-based preventive services under the Affordable Care Act. The amicus brief demonstrates that preventive services save lives and are cost-effective, and outlines examples of the cost-free services that would be lost for many patients if the lower court’s adverse decision is upheld.  
  • KFF, the noted health policy research outfit, published an initial report on findings from a comprehensive study of consumer experiences with health insurance. KFF found, among other things, that: most insured adults give their own health insurance positive ratings (though people with more health needs gave lower ratings); despite those generally positive ratings, most insured adults report experiencing problems when they use their health insurance; affordability of premiums and out-of-pocket spending are a concern for about half of all privately insured consumers, with 4:10 adults skipping or delaying care due to cost; and insured adults overwhelmingly support policies to make insurance simpler to understand and use. 
  • On June 21, 2023, 230 House members and 61 Senators wrote to the U.S. Centers for Medicare and Medicaid Services urging CMS to finalize rules (proposed last December) that would require Medicare Advantage plans to modernize and streamline the prior authorization process. The lawmakers called for: real-time prior authorization for routine care; a 24-hour deadline for “urgently needed care”; and more transparency around plans’ prior authorization metrics. 
  • The House Education and Workforce Committee advanced two partisan bills pitched as measures that would expand insurance options for small businesses. HFA and allied patient advocates voiced concerns that both bills would sidestep consumer protections and coverage requirements under the ACA.