Millions could lose coverage this year when federal protection expires

Thousands of South Carolina children and millions across the country could lose the Medicaid coverage they gained during the pandemic after federal protections expire later this year, advocates said.

They are calling on state agencies like the S.C. Department of Health and Human Services to do more to keep children and families in the program.

Congress passed the Families First Coronavirus Response Act soon after the pandemic began that offered states a deal: The federal government would increase the matching funds it pays states for Medicaid by 6.2 percent if the state essentially agreed to not kick anyone off the program while the Public Health Emergency declaration was in effect.

South Carolina and other states usually do an annual review to see if a person is still eligible for Medicaid but agreed to forego that.

Due to income losses and parents who lost jobs during the pandemic, millions of children were suddenly eligible and covered by Medicaid or the Children's Health Insurance Program, which provides coverage at higher income levels. The number could be nearly 7 million children nationwide, including almost 80,000 in South Carolina who gained coverage as of March 31, according to an analysis of data from the state Department of Health and Human Services.

South Carolina's Medicaid rolls increased overall from 1,044,980 in February 2020 to approximately 1.25 million as of March 31, an increase of 19.6 percent, according to an analysis of public data.

Nationally, state Medicaid programs will have grown by 25 percent between 2019 and the end of fiscal year 2022, or by about 22.2 million people, of whom 42 percent are children, according to the Kaiser Family Foundation. While some of that is due to a few states expanding Medicaid and other expected growth, much of it is due to the pandemic-related increase, the foundation found.

Once added, they stayed on as the emergency declaration has been extended by 90 days several times since 2020, most recently in April, and was set to expire July 15. However, the Biden administration assured states it would give them 60 days' notice before it ended the declaration, and that deadline passed May 16 with no official word from the U.S. Department of Health and Human Services.

"We're hoping that no news is good news at this point," said Sue Berkowitz, director of South Carolina Appleseed Legal Justice Center, which advocates for health reform and Medicaid expansion among other issues.

"I don't think we are going to get any kind of notice," said Tricia Brooks of the Georgetown Center. Instead, the department will just issue a new declaration as it has done before previous deadlines.

"I would be flabbergasted if it is not extended," Brooks said.

Several powerful groups, including the American Hospital Association, the American Medical Association and the American Academy of Pediatrics, wrote earlier this month to HHS Secretary Xavier Becerra urging him to extend the deadline in part to avoid the potential loss of coverage, particularly amid rising COVID-19 cases.

"Those that are closest to health care and what this would mean, particularly for low-income families, know that we are not out of the woods yet," Brooks said. "This continuous coverage provision has been critical to the United States avoiding a surge in the number of uninsured people."

If extended again, the deadline would move to mid-October. Reassessments of eligibility would begin the following month. And that's when advocates fear the chaos could start.

"Without having a huge, huge public push (for educating those affected), I really worry it is going to be a lot of kids and adults getting disenrolled," Berkowitz said. "While some will be able to come back on, there will be a huge churn."

The fear is not that adults and children will be found to be ineligible; it is the fear they will not receive the notice that allows them to continue coverage or participate in the redetermination process. If a state sends a letter, it may not find people who have moved in the last two years and there has been a lot of disruption and transitions during the pandemic, Brooks and Berkowitz said.

"We know that folks have moved and haven't gotten their notices," Berkowitz said.

Or the notices themselves may be difficult to understand and comply with, Brooks said.

South Carolina Health and Human Services does appear to have a comprehensive plan for reaching out to those on Medicaid. According to a presentation to the Medical Care Advisory Committee earlier this month, the agency will first try to use information it can access electronically to determine if the person is still eligible, such as wage and salary data from the South Carolina Department of Employment and Workforce and other state and federal agencies, spokesman Jeff Leieritz said.

For those it cannot confirm that way, it plans to send a notice to members about the redetermination 60 days in advance of the deadline, and then a follow-up notice 30 days later before ending eligibility. But the agency is already reaching out to those on Medicaid to try and get updated information and it plans to use text messages and phone calls, as well as working with the managed-care organizations that administer some Medicaid health plans, to reach those members.

"And that's great," Brooks said. "That's exactly what we want to see happening."

The state agency also plans to take advantage of flexibility the federal government offered to spread the redetermination process out over 12 months and will not exceed more than a certain amount of reviews in any given month to create a "balanced workload" that should help minimize disruption, according to the agency presentation. The agency also presented a communication plan that includes speakers, videos and social media.

Berkowitz wants to see churches and pastors get involved as well to help spread the word and prevent disenrolling people who deserve and need the coverage.

"It really could become a huge disruption for our health care system," she said. "As a state, if we can avoid all of this, why would we not do that?"