Medicaid expansion debate takes twist: The end of one emergency could trigger another in Kansas
Kansans are used to a particular kind of debate over Medicaid expansion.
Lawmakers in the Sunflower State have scrapped for years over whether to take advantage of a provision in the Affordable Care Act allowing states to expand the health care program covering low-income residents to those making 138% of the federal poverty level.
But a lesser-known feature of the COVID-19 pandemic has prompted a different kind of Medicaid expansion, thanks to the ongoing public health emergency, declared in 2020 due to the virus and renewed regularly by President
The federal government has required states not kick individuals off Medicaid during the public health emergency, a mandate that dates back to the early days of the pandemic.
But when the emergency eventually ends, expected to be some time in 2023, there is certain to be a deluge of individuals whose eligibility for Medicaid the state will have to determine. And research points to a heightened risk that this process will leave many without coverage — potentially over 100,000 individuals.
"We know the pandemic caused people to stop going to health care for a little while," said
End of public health emergency could impact 125,000 Kansans
When lawmakers converged in
But also included was the ability for the federal government to pay an increased share of Medicaid costs, with expenses related to the program generally shared between the state and federal government. Such a move often occurs during economic downturns, when the number of individuals on the Medicaid rolls can swell due to financial turmoil.
In exchange, states had to keep individuals continuously enrolled in Medicaid, preventing them from booting residents off the program if they became ineligible. This also designed to reduce the burden on individuals who should remain covered but struggle to prove their eligibility, a process that often creates an array of bureaucratic hassles.
Nationally, this has grown the number of individuals covered by Medicaid substantially. Data from the
This has also been true in
Some of these individuals are simply no longer eligible for KanCare but were preserved from being kicked off during the pandemic because of the health emergency.
But others could be victims of a phenomenon known as "churn," where individuals are disenrolled and then re-enrolled in a short period of time, causing a coverage gap.
This can happen for a variety of reasons. Sometimes a person temporarily makes too much to qualify for Medicaid. Other times they encounter hurdles in re-enrolling, such as missing a notice in the mail or even running into problems that require phoning the program call center.
To understand how big of a problem churn poses, a
"It could double the number of uninsured children in this country," said
While losing coverage for any length of time can have an adverse impact on adults and children alike, the impact on younger Kansans is greater, said
Not having health insurance means missing well-child visits, routine treatments and screenings and even childhood immunizations.
"Whether they get care can affect the trajectory of their lives," Braum said.
The end of the Medicaid protections would also create a significant logistical hurdle for states, who already do not always handle new applications in a timely manner.
KanCare data, for instance, shows that 352 applications currently pending had not been processed within the federally required 45-day window, about 8% of open applications. Other states, like
Now the state will have a deluge of eligibility determinations to make, after months of not having to do so.
To attempt to manage volume, the state is taking the federal government up on a provision to spread the determinations out over 14 months, rather than attempting to tackle them in a much more compressed timeframe.
Still, there is an understanding that the state's infrastructure could be strained. Hiring workers for the state's call center, which is run by a third-party contractor, has remained a struggle, for instance.
"Not only do we need to boost capacity, because this is going to be a much larger volume of transactions that have to occur than have ever occurred before," Brooks said. "But it comes at a time when states are challenged in recruiting and retaining employees."
And states vary in how prepared their information technology setup is to cope.
But experts say the state has also undergone needed technology improvements in recent years, including a long-desired move to allow individuals to renew and check the status of their accounts online. Lawmakers report fewer complaints from weary constituents as well.
"The system that you're using must be working a lot better because we haven't had, knock on wood, anyone that frustrated, the way it was before," said Rep.
And Palmer, the KanCare director of eligibility, said the agency was emphasizing outreach to individuals enrolled in the program to encourage them to ensure contact information was up to date, thus increasing the odds that crucial information on renewals would get to their intended destination.
Other entities are also planning their own messaging and outreach.
The state will be spreading the renewals out over the entire 14-month period, meaning Weingartner, of
"Some of those things are happening already," she said of the efforts to inform residents. "But it's as we get closer to figuring out when this is truly going to kick off that's when I think you'll see a big lift for that."
Emergency end set to renew debate over Medicaid expansion
The public health emergency won't end in January, after President
Such a move has prompted controversy and even an effort, spearheaded by
But when the time comes to end the emergency, it will renew a debate that has brewed in
Of those who lose coverage due to no longer being eligible, many will fall into the so-called "doughnut hole," where they make too much money to qualify for Medicaid but too little to qualify for subsidized coverage on the health care exchanges created under the Affordable Care Act.
Gov.
"We need to bring that money home to
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"It's tough to get around given leadership positions and that kind of stuff in the Legislature," said
Weingartner said
"The reality is, this is where we are today," she said. "And this is the system we have to work within. And so we want to make sure that we connect with as many people as we can to make sure that they can either maintain their coverage or find some alternative coverage."
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