A $1.7 trillion omnibus spending package recently signed into law allows states to begin Medicaid redeterminations April 1, prior to the expiration of the COVID-19 public health emergency, with one year to complete them.
As states conduct redeterminations, the enhanced Federal Medicaid Assistance Percentage will continue to be available to them through Dec. 31, under certain conditions.1
The PHE has been extended to mid-April and about 18 million people are expected to lose coverage after the PHE ends but could find coverage via the Affordable Care Act.1
Giving states additional lead time to work with managed care plans and begin redeterminations is expected to lead to fewer people losing health insurance coverage.1 CMS just released guidance on how states and managed care plans can “help ensure eligible enrollees retain coverage in Medicaid and CHIP and ease transitions for individuals eligible for coverage through the marketplace.”2
The agency proposes four strategies for states to work with managed care plans:
- Partnering with plans to obtain and update beneficiary contract information.
- Sharing renewal files with plans to conduct outreach and provide support to those enrolled in Medicaid during their renewal period.
- Allowing plans to reach out to beneficiaries who have recently lost coverage for procedural reasons.
- Allowing plans to help people transition to and enroll in marketplace coverage if they are not eligible for Medicaid and CHIP.
The guidance also includes five scenarios demonstrating practical applications of these strategies.
The new law also requires Medicaid programs to provide children with continuous coverage for 12 months and permanently allows states to offer women 12 months of coverage postpartum.1 As of now, states may choose to provide 12 months of continuous coverage for children in Medicaid or CHIP.3
Additionally, as of Jan. 1, 2024, states would need to ensure that children eligible for Medicaid have continuous eligibility for 12 months.1 States are only permitted to renew coverage for children once per year, but it is possible for children to lose coverage before that period if their circumstances change or if data checks uncover information that affects their eligibility.3
Kaiser Family Foundation notes that “12-month continuous eligibility policies are effective tools to reduce Medicaid disenrollment and churn rates within the year.” 3
As for the PHE, Biden administration officials have said the end date could come as early as spring.4 With the new omnibus law and the latest extension of the PHE, states and their Medicaid partners have more time to conduct outreach and help ensure all beneficiaries are part of a plan that will provide the care they need.
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- Morse, S. Omnibus spending bill gives states a heads-up on Medicaid coverage. Healthcare Finance News. Dec. 27, 2022. https://www.healthcarefinancenews.com/news/omnibus-spending-bill-gives-states-gets-heads-medicaid-coverage
- Cass, A. CMS outlines Medicaid redetermination strategies for states. Becker’s Payer Issues. Jan. 10, 2022. https://www.beckerspayer.com/payer/cms-outlines-medicaid-redetermination-strategies-for-states.html
- Williams, E., Corallo, B., Tolbert, J., et al. Implications of continuous eligibility policies for children’s Medicaid enrollment churn. KFF. Dec. 21, 2022. https://www.kff.org/medicaid/issue-brief/implications-of-continuous-eligibility-policies-for-childrens-medicaid-enrollment-churn/
- Cancryn, A. Biden team eyes end of Covid emergency declaration and shift in Covid team. Politico. Jan. 10, 2023. https://www.politico.com/news/2023/01/10/biden-covid-public-health-emergency-extension-00077154