PLANNING AHEAD: What you need to know when the public health emergency ends [Column]

In the wild, complicated world of health insurance we are experiencing today, complicated further by three years of the global COVID-19 pandemic, it can be excusable to lose track of what is happening regarding health insurance coverage.

It can even be more bewildering to discuss emergency actions taken and their relationship to Medicaid and other government assisted programs.

It is now time, however, to begin to discuss the unwinding of crisis measures taken for this time referred to popularly as the PHE or Public Health Emergency and what effect this might have on average health care recipients.

The first point to know is that changes being put in motion as a result of the diminishing effect of COVID-19 will affect most directly those who are currently Medicaid recipients and will involve reviews of continued Medicaid coverage. It does not mean Medicaid will end but it does mean cases will be reviewed to see whether individuals still qualify. Therefore these individuals and their supporters need to be diligent to assure that they stay alert to continuing their coverage or, in the appropriate case, to obtain alternative coverage either through other programs or in the open market.

First, the history as to how this came about. In response to the pandemic, the federal government declared a public health emergency on Jan. 1, 2020. In connection with this, Congress enacted the Families First Coronavirus Response Act (FFCRA) which, among other things, was intended to increase federal money spent on Medicaid programs. The Families First Coronavirus Response Act was expected to be a temporary measure. Its effect was to assist individuals and families during a particularly difficult time.

During the Public Health Emergency, the federal government basically mandated that, in exchange for higher reimbursement of Medicaid costs to the states in a change to what is referred to as the FMAP or Federal Medical Assistance Percentage, states would not remove individuals already on Medicaid from the program even if they would otherwise not continue to qualify either because their income or assets had changed, their status had changed, or otherwise. Now, with the Public Health Emergency ending, states will have twelve months to evaluate the continued eligibility of Medicaid recipients to determine whether they still qualify for the program. Although, the official date for the end of the Public Health Emergency (PHE) for COVID-19 is May 11, 2023, this does not mean that all Medicaid recipients would be immediately reviewed, a project that would resource wise be virtually impossible. It does mean that if you or a family member or close friend is on Medicaid it can be time to review qualifications to see if you still qualify and to make sure the government can contact you, that requests for information are answered and paperwork up to date.

Here are some considerations. First, individual states have a great deal of flexibility regarding how they administer the program so you can expect differences from state to state. Also, even if an individual does not qualify for continued Medicaid there may be other programs that could substitute and fill the gaps — Medicaid expansion and coverage under the Affordable Care Act (Obamacare) come to mind in this respect. We can expect confusion while all of this takes place. Remember that Medicaid is both a program for nursing home care and at-home waiver type programs and rules are different for each.

So, here are things you should consider. This information is adapted from the Administration for Community Living (ACL) Fact Sheet, "ACL Fact Sheet: Preparing for Medicaid Changes When the Public Health Emergency Expires,"

Medicaid beneficiaries should make sure that their Medicaid agency has their current contact information.

Medicaid recipients (or presumably their agents and representatives) should check the mail and be sure to mail back any Medicaid forms they receive.

Note that all renewal forms and notices must be accessible to people with limited English proficiency and people with disabilities.

Many people who are no longer eligible for Medicaid will likely have other coverage options.

If someone is disenrolled or their Medicaid coverage changes and they disagree with their state Medicaid agency's decision, they can appeal. However, note there are time limitations.

The end of the Public Health Emergency may lead to an increase in utilization of services provided by Older Americans Act programs, Centers for Independent Living, Assistive Technology Act programs, and other grantees.

Janet Colliton, Esq. is a Certified Elder Law Attorney recognized as a specialty by the American Bar Assn. and the Pennsylvania Supreme Court. Her practice, Colliton Elder Law Associates, PC is limited to elder law, retirement planning, life care, special needs, guardianship, and estate planning and administration, with offices at 790 East Market St., Ste. 250, West Chester, 610-436-6674, [email protected]. She is a member of the National Academy of Elder Law Attorneys and, with Jeffrey Jones, CSA, co-founder of Life Transition Services LLC, a service for families with long term care needs.