Medicaid Directors Cautiously Prepare For PHE To Expire In January

Inside Health Policy

November 22, 2021 3:39 pm

State Medicaid directors are getting anxious as the Biden administration has yet to announce whether it will extend the public health emergency beyond mid-January, making it difficult for them to prepare to restart the process of reviewing Medicaid beneficiary eligibility and train staff on a renewal process that hasn’t been done in nearly two years. One state Medicaid director said about 40% of his staff have never done an eligibility redetermination before.

The National Association of Medicaid Directors asked the Biden administration and Congress last month for longer-term certainty on when the public health emergency will end as its expiration marks when states can begin removing people from Medicaid.

Congress required states beginning in early 2020 to keep Medicaid beneficiaries continuously enrolled throughout the COVID-19 public health emergency as a condition of receiving more federal Medicaid money. Lawmakers’ goal with the so-called maintenance of effort requirement is to keep people from losing access to health insurance during the pandemic, but now the question is how should states resume checking beneficiaries’ eligibility and kicking ineligible people off the rolls.

The Biden administration revised Trump-era guidance in August to give states a full year to resume normal operations, and Congress is slowly moving along with their own plan under the Build Back Better Act that ties in several of Medicaid directors’ requests.

Included in the House-passed Build Back Better plan is a provision that would decouple the maintenance of effort requirement from the public health emergency and phase out the 6.2% bump in federal Medicaid matching funds beginning March 31, 2022. Otherwise, states will lose their enhanced funding at the end of the quarter that the public health emergency expires.

HHS Secretary Xavier Becerra last renewed the COVID-19 public health emergency for 90 days on Oct. 15, but the administration hasn’t announced a new end date for states. HHS did not respond by press time on whether plans have changed or are in flux.

Until that’s finalized, states are relying on the administration’s initial deadline of January 2022 and its promise to give states 60 days’ notice before letting the PHE expire. This means while the Congressional Budget Office estimated in July the PHE would last through July 2022, state Medicaid offices are assuming any day the administration will announce the PHE expires in 60 days.

“So did anybody hear that they were ending the public health emergency in 60 days?” Jim Jones, Wisconsin Department of Health Services Medicaid director, asked on Tuesday (Nov. 16) during an NAMD conference panel. “Because they’re supposed to give us notice of 60 days, so apparently it’s now January 17.”

Jones was part of a panel at the NAMD conference that reviewed several challenges this constantly moving deadline poses, including when to roll out technology updates and retrain staff.

“I got 40% of the workers in our income maintenance agencies who’ve never done a renewal; they’ve never actually terminated anyone. So that’s going to be interesting,” Jones said. “And we, you know, we need to go back and probably retrain, you know, the 1,200 workers we have on how to do renewal the right way, how to do administrative renewals, etc.”

Jones is also worried about contacting Wisconsin Medicaid beneficiaries when the time comes to restart renewals as many might not have updated their home addresses and won’t receive their redetermination notice.

The top concern for another panelist, Arizona Health Care Cost Containment System Chief Actuary Colby Schaeffer, is gathering enough data so he can project costs.

“The risk profile of people has completely changed,” Schaeffer said. “There is so much more telehealth now. There’s obviously going to be a behavioral health crisis. There’s many studies that support that there’s going to be increased demand there.”

“I’d like to think that most of that downward utilization and services that you saw in spring of 2020, that it kind of returned to normal, but they’re still going to be some of that pent up demand,” Schaeffer continued. “The underlying Medicaid beneficiary has changed as well; the workforce has really changed. So like, who are we dealing with in the back end of this?”

Schaeffer estimates anywhere from 20% to 50% of beneficiaries could stay on Medicaid rolls after the maintenance of effort ends, and it will take roughly 10 months to complete every beneficiary’s redetermination. Estimates from earlier this year showed up to 30% of Medicaid enrollees could lose insurance after the public health emergency ends.

CMS Administrator Chiquita Brooks-LaSure promised NAMD conference attendees the agency will continue working with states on how to resume usual operations when conducting beneficiary eligibility. She said the conversation goes beyond Medicaid, and CMS tried to take into account states kicking beneficiaries out of Medicaid when writing the marketplace rules.

“On this issue in particular, we have the whole CMS — every office — thinking about how do we proceed in thinking about this unwinding?” Brooks-LaSure said. “So this is not just a Medicaid discussion. This is all of our IT folks, our marketplace folks, our duals office, our Medicare, we’re all thinking about how do we ensure that we hold on to the coverage gains that we have made in 2021 and whether people are staying in coverage or shifting to make sure that we hold on to coverage.”