Massive Medicaid purge begins July 1

The planned May 11 ending of the national COVID-19 public-health emergency is the catalyst for several significant changes.

According to a Jan. 27 letter from the federal Centers for Disease Control and Prevention to state health directors, the May 11 deadline triggers the March 31 ending of eligibility for the temporary Medicaid coverage.

The March 31 expiration "enables states to terminate Medicaid enrollment of individuals who no longer meet Medicaid eligibility requirements on or after April 1."

"We recognize people will lose coverage in this process, but our goal is to ensure people eligible for Medicaid do not lose coverage, and those no longer eligible are transitioned smoothly to affordable health plans," DHHS said.

April 1, however, does not have to serve as a strict cut-off designation.

CMS amended the conditions that states must meet to allow for a gradual removal of the temporary beneficiaries that could extend coverage through at least the end of the year.

That includes determining if the temporary beneficiary now qualifies for permanent Medicaid coverage.

DHHS said last week it will start the redetermination process on April 1, with each renewal review taking up to 90 days.

"We expect to start the renewal process for the last group by March 31, 2024," DHHS said in a news release.

"Per CMS guidance, we have 12 months to complete the process. The first day people would not have coverage would be July 1."

Kaiser Health News said the ending of the coverage will put pressure on state and local health departments to disenroll those no longer qualified while directing them to other potential sources of coverage.

There also will be added financial pressures on health-care systems, hospitals, doctors and other providers who rely on payments from Medicaid.

DHHS said it has been "preparing for the massive task of requalifying Medicaid beneficiaries for coverage."

DHHS said affected temporary beneficiaries will receive a notice saying they do not have coverage and how to find insurance on the exchange.

"This is a longstanding federal requirement/process that we have followed when anyone is no longer eligible for Medicaid coverage, and we coordinate closely with healthcare.gov," DHHS said.

"Additionally, we are exploring options, including telephone calls, text messages, social media, push notifications to enhanced ePass/NC FAST accounts (online benefits tool), partner/stakeholder communications, and communications/press releases to the North Carolina media.

"Additionally, our Medicaid health plans are providing comprehensive communications and information to beneficiaries. We are also exploring options to support our county Department of Social Services offices and their workers as they complete the re-determination process."

Medicaid expansion

The end of the temporary coverage comes as the latest state House attempt at expanding the state's Medicaid program was filed on Wednesday.

DHHS said that "many of these beneficiaries would be eligible for health care coverage under Medicaid expansion, which the legislature is considering."

The House reintroduced its "clean" version of a bipartisan Medicaid expansion bill, officially beginning a potentially legislative-defining debate for the 2023 session.

Clean, in this instance, means no additional health-care reform language remains in House Bill 76 - a major component of Senate Republican leaders' quid-pro-quo preference for Medicaid expansion.

HB76, titled "Access to Healthcare Options," has Rep. Donny Lambeth, R-Forsyth, as its primary sponsor and bill author. There are two Republican and one Democratic co-primary sponsors.

Pivotally, HB76 is tied directly to expected funding appropriations within the 2023-24 state budget and only goes into effect when the budget become law/

If the 2023-24 state budget hasn't become law by Dec. 31, the legislation within HB76 "shall expire."

The bill was filed without comment by House speaker Tim Moore, R-Cleveland.

Lambeth said the plan is to have HB76 take the fast-track committee approach early next week, clearing the Health, Finance and Rules and Operations committees to "have it on the House floor for its first vote no later than Wednesday."

The Health committee meeting is set for 10 a.m. Tuesday.

Lambeth said HB76 is "a good option for North Carolina and incorporates several of the best practices we researched and heard about from other states."

"The expansion benefits many of our citizens, including veterans, farmers and many others who work, but cannot afford private insurance. This is a win-win."

Lambeth said part of HB76's appeal is the "focus on preventive and well care, encouraging participants to take care of themselves."

Local impact

The planned May 11 ending of the national COVID-19 public-health emergency also will affect the local availability of test kits and vaccines, Forsyth County health director Joshua Swift said.

The Biden administration's decision also has ramifications for 589,000 North Carolinians who have gained Medicaid coverage during the COVID-19 pandemic through federal public-health relief legislation.

Swift said DHHS-supported vendor testing is expected to end by March 30.

At that time, the health department will lose many of its administrative and clinical workers dedicated to COVID-19 services as state and federal funding for those positions ends.

"When that happens, we'll have to assimilate the (COVID-19) vaccine operations into our normal vaccine operations," Swift said. "Losing that support in staffing and funding will be challenging."

Meanwhile, it's expected that Moderna and Pfizer will begin commercial marketplace sales of their vaccines in March and April.

That means county health departments, health-care providers and hospital pharmacies could be charged between $100 and $120 per vaccine dose.

By comparison, Swift said the flu vaccine costs between $10 and $15 a dose.

"We do believe that health insurance companies will obviously allow that coverage, but we're looking into that as we chart this new course with COVID in how we'll handle not only testing, but also the vaccine," Swift said. "The vaccine remains readily available."

Swift said the county health department should have enough COVID-19 test kits to last for another 12 months at the current usage rate of about 400 to 500 a month.

Awareness

The Robert Wood Johnson Foundation reported Thursday that 64% of adults in a Medicaid-enrolled family reported having no awareness that their eligibility for the program will be reviewed and may expire. The report was conducted by the Urban Institute.

"Lack of awareness may mean enrollees are not prepared to complete the necessary steps to maintain Medicaid coverage or, if they are no longer eligible, obtain coverage elsewhere," according to the report.

"Only 5% of adults who are enrolled in Medicaid, or have a family member enrolled, reported hearing a lot about the upcoming changes in renewal processes."

Just 14% of adults reported they had heard some about the return to regular Medicaid renewal processes, while 5% of adults reported they had heard a lot about the return to regular Medicaid renewal processes.

Awareness was low across the country regardless of geographic region or whether the state has expanded Medicaid eligibility: Low awareness was 66.5% in the Northeast; 67.6% in the Midwest; 63.4% in the South and 61.3% in the West.

There was similar lack of awareness in Medicaid expansion states at 64.5% and non-expansion states, such as North Carolina, at 63.7.%

"The end of the public health emergency's continuous coverage requirement means millions of people are at risk of losing continuous coverage in Medicaid, which they have relied upon for nearly three years," said Gina Hijjawi, the foundation's senior program officer.

"States and the federal government must quickly raise awareness that many families will soon need to take steps to maintain or find new health coverage."

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