Where telehealth fits in to the Medicaid unwinding

WASHINGTON - The COVID-19 public health emergency ends May 11 and those who became eligible for Medicaid coverage as a result of pandemic-related legislation are subject to disenrolling from coverage in April.

Robin Kingston and Bryce Miller of Teladoc Health discussed some things to expect as the nation moves beyond the COVID-19 emergency. Their presentation was part of America’s Health Insurance Plans’ 2023 Medicare, Medicaid, Duals and Commercial Markets Forum.

Although many have referred to the Medicaid redetermination as “the great unwinding,” Kingston referred to it as “the big switch.”

“The individuals who will be redetermined for Medicaid eligibility - and particularly those who will lose coverage - will go somewhere. They will still need care. The industry needs to have a plan to help manage these members and deal with the potential health care status they will come in to that coverage with.”

She described the Medicaid unwinding process as having two phases.

Phase 1 – Preparing for the end of the PHE. Several challenges are associated with this phase, Kingston said. The first is a lack of awareness among Medicaid recipients that they must update their information. She cited an Urban Institute report from December that said aid 64% of Medicaid recipients did not know about redetermination.

Another challenge is finding Medicaid recipients and communicating with them. Some recipients are transient, some are differently abled and some have limited English proficiency. In addition, each state has different plans, timelines and waivers surrounding the Medicaid unwinding.

Phase 2 – New coverage. At this point, the recipient either remains eligible for Medicaid or is moved into other types of coverage. Some issues surrounding this phase include potential gaps in care, chronic care condition management, a need for care coordination, and access to primary care providers as well as mental health and specialty care networks.

In addition, Kingston said, Medicaid recipients who transition to other coverage face a health equity challenge. “Will they have culturally competent care? Will they have care they are comfortable with?”

Miller said another challenge facing the health care system is a lack of access to primary care. He said 99 million Americans have little to no access to primary care, it takes an average of 26 days to obtain a  new patient visit in a major U.S. metropolitan area, and only 28% of U.S. adults had a wellness visit last year.

Telehealth can help expand access to care, he said.

He cited statistics that showed among those who use Teledoc’s P360 service, 65% had not seen a primary care provider in the past two years, 36% with diabetes were newly diagnosed, and more than 50% of those with hypertension improved their blood pressure.

Susan Rupe is managing editor for InsuranceNewsNet. She formerly served as communications director for an insurance agents' association and was an award-winning newspaper reporter and editor. Contact her at [email protected]. Follow her on Twitter @INNsusan.

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Susan Rupe is editor in chief, magazine, for InsuranceNewsNet. She formerly served as communications director for an insurance agents' association and was an award-winning newspaper reporter and editor. Contact her at [email protected].