Kathleen Stoll: Omnibus bill could hurt those on Medicaid

Tens of thousands of West Virginians are at risk of losing their Medicaid in 2023. Included in the big omnibus budget and legislative package that Congress passed on Dec. 23 was a provision that ends a COVID-era emergency rule that protected Medicaid enrollees.

While Congress did not mandate an end to the overall COVID public health emergency, they did mandate the end of the emergency Medicaid continuous eligibility provision that has been part of the COVID public health emergency rules since 2020. Thanks to this special continuous coverage requirement, people on Medicaid were not at risk of losing Medicaid or falling off the rolls.

Medicaid was a key part of how our nation responded to the financial strain COVID placed on many people, families, hospitals and health care providers. By preventing states from disenrolling people from Medicaid coverage, the continuous enrollment requirement has helped keep folks insured and able to access health care during the pandemic. It guaranteed that hospitals and other providers would be reimbursed for COVID care and treatment. It made sure people who felt sick sought care. The protection saved lives.

However, on April 1, regardless of what is happening with COVID or whether the federal COVID public health emergency is declared over or continuing, states must begin processing Medicaid redeterminations, and millions of people could lose coverage. Some will lose coverage because they are no longer eligible. Others — and this is the tragedy — will lose coverage during the redetermination process even if they continue to be otherwise eligible because of a procedural issue or administrative barrier.

With the congressionally mandated “unwind” of Medicaid continuous eligibility protections, West Virginia and all other states will have a maximum of 14 months starting in April to redetermine who is still eligible to stay on Medicaid.

Since February 2020, national Medicaid/CHIP enrollment increased by 27.1% (19.3 million enrollees) by August 2022. The Kaiser Family Foundation estimates that between 5.3 million and 14.2 million people will lose Medicaid coverage during the 14-month unwinding. Estimates from the Department of Health and Human Services suggest that as many as 15 million people will be disenrolled from Medicaid, including 6.8 million who should still be eligible but fall off the rolls because they can’t be reached or for other procedural problems.

In West Virginia, the number of Medicaid enrollees who could lose coverage in 2023 is highly uncertain. In August, more than 600,000 West Virginians were enrolled in Medicaid. Estimates are that between 5% and 13% of these Medicaid enrollees are at risk of losing coverage — 30,000 to 78,000 people.

Efforts to conduct outreach, education and provide enrollment assistance can make the difference in how many people are disenrolled who remain eligible for Medicaid. It also can help those who are no longer eligible for Medicaid transition to coverage from the state health insurance marketplace at healthcare.gov.

If you are on Medicaid now, it is very important that you act to keep from losing your coverage or to get help to move to new coverage from healthcare.gov. That means updating your contact information.

There’s a lot of detail about this redetermination process and some new federal policies that our state can embrace to keep folks from inappropriately falling off the rolls. With that said, the bottom line is that, if the state can’t find you, you could lose your Medicaid, be caught off-guard and experience a gap in coverage. The Wests Virginia Department of Health and Human Resources will send you notices in the mail to let you know what you need to do to keep Medicaid. But you won’t get that information if the DHHR can’t find you.

I strongly encourage every West Virginian on Medicaid to make sure their contact information is up to date with the state. Your Medicaid card might show that your coverage is delivered through a managed care organization — Unicare, The Health Plan or Aetna Better Health — remember, it is all Medicaid.

You can update your contact information by contacting the DHHR’s Office of Customer Services by phone, at 1-877-716-1212; email at dhhrbcfchangectr@wv .gov; fax at 304-558-1869; or mail at P.O. Box 1668, Charleston, WV 25326-1668.

You also can report changes at wvpath.wv.org

If you are no longer eligible for Medicaid, you can get help finding a subsidized low-premium health plan on the state health marketplace. Contact the WV Navigator program for help with Medicaid renewals or for help picking a new health plan. You can call 1-304-356-5834; email navigator@firstchoice services.org; visit www.wvnav igator.com; or go to facebook.com /wvnavigator.

The DHHR is working hard to get the word out. Consumer advocacy organizations and provider associations across the state — as well as our state’s three Medicaid managed care organizations — also are helping spread the word.

Ultimately, it will be up to the individual on Medicaid to make sure their contact information is current, or risk unnecessarily losing Medicaid. For those who think failing to update their contact information will let them fall through the cracks and preserve their Medicaid eligibility, you are wrong. If you have a new phone number or address or email box, please make sure you provide that information to the DHHR.