Protect Our Care: Reps. Barragan, Chu, Horsford Call for Immediate Action to Keep People Covered as Medicaid Continuous Coverage Requirement Ends

WASHINGTON, March 21 (TNSgov) -- Protect Our Care issued the following news and letter:

U.S. Representatives and Tri-Caucus Chairs Nanette Barragan, Judy Chu, and Steven Horsford, joined civil rights leaders and Protect Our Care for a press conference releasing a letter to the Department of Health and Human Services (HHS) calling for state and federal action to keep families in America covered as Medicaid's continuous coverage requirement ends. The letter stresses the importance of states meeting their obligations to ensure that millions of people in America do not lose critical health care coverage, and calls on HHS to clearly define and enforce states' legal obligations. The Tri-Caucus letter is supported by Protect Our Care, Asian & Pacific Islander American Health Forum, Coalition on Human Needs, Families USA, Leadership Conference on Civil and Human Rights, NAACP, National Urban League, and UnidosUS.

Congress passed legislation at the beginning of the COVID-19 pandemic to protect access to Medicaid by ensuring no one could be disenrolled during the public health emergency. This provision, which has helped secure the lowest level of uninsured Americans ever, is set to expire on April 1. This would potentially result in an estimated 15 million people potentially losing coverage, disproportionately affecting people of color and children. The Biden-Harris administration has committed to expanding access to care and providing guidance to states to assess eligibility in a way that will minimize coverage losses, particularly for children, people of color, people with disabilities, and others who rely on the Medicaid program for their health care.

"Millions of Latinos were able to access life-saving health insurance coverage as a result of the Medicaid continuous coverage requirement and these historic gains must not be erased when states resume Medicaid unwinding," said U.S. Representative and CHC Chair Nanette Barragan (D-CA-44). "As states begin to review Medicaid eligibility, millions of low-income beneficiaries are at risk of becoming uninsured if the program operates as it did in the past. Sixty-four percent of Latinos covered by Medicaid are poised to lose coverage, despite remaining eligible. Secretary Becerra must act boldly and use his new enforcement authority to minimize disparities in coverage rates and affordability of care. I thank my Tri-Caucus colleagues for highlighting the dire need to keep Americans covered as Medicaid's continuous coverage requirement ends."

"I am gravely concerned that when states resume the 'unwinding' of the Medicaid continuous coverage requirement in April, millions of low-income beneficiaries, including Asian Americans, Native Hawaiians, and Pacific Islanders (AANHPIs) and other communities of color, will unnecessarily lose essential health insurance," said U.S. Representative and CAPAC Chair Judy Chu (D-CA-28). "Once Medicaid terminations resume, nearly one million Asian Americans and Pacific Islanders stand to lose coverage, and one-tenth of all Native Hawaiian and Pacific Islander children will be dropped from the program. Secretary Becerra must use his new enforcement authority to protect health care access for all struggling families and enrolled children, including those belonging to AANHPI communities."

"We cannot afford to roll back the hard-fought progress we have made on Medicaid, which has helped to narrow racial disparities in health coverage and provide much needed access to life-saving care in communities of color. If Medicaid terminations resume, more than 2 million Black Americans nationwide will lose access to life-saving health care despite their eligibility," said U.S. Representative and CBC Chair Steven Horsford (D-NV-04). "The Congressional Black Caucus has long prioritized advancing equity in health care in our communities and we join our Tri-Caucus colleagues in calling on HHS Secretary Becerra to take action to preserve beneficiary access to Medicaid coverage and stop eligible Medicaid families from improperly losing health care coverage."

"Medicaid Unwinding puts millions of families, including one million Asian American, Native Hawaiian, and Pacific Islander individuals, at risk of being uninsured. We know that so many people across federal and state administrations are working hard to preserve and assist these vulnerable individuals, but more needs to be done. Our Asian American, Native Hawaiian, and Pacific Islander communities require support, including more in-language materials, Navigators, and outreach from trusted messengers to ensure no one is left behind," said Juliet K. Choi, President and CEO, Asian & Pacific Islander American Health Forum.

"The Medicaid redetermination period will be perilous for communities of color without meaningful state efforts and federal oversight," said Marc Morial, President and CEO, National Urban League. "Forty-seven percent of Black people covered by Medicaid are poised to lose coverage - despite remaining eligible - simply because of red tape. We thank the leadership and members of the Tri Caucus for engaging on this vital civil rights issue."

"An historic number of Americans, including five million Latinos, are likely to lose their health coverage unless the Biden-Harris Administration acts quickly and boldly to protect Medicaid. Absent immediate intervention, when the continuous coverage requirements expire on April 1, our country faces the loss of health care for millions of families and children and the exacerbation of the health inequities that made the pandemic so deadly for so many communities. For the benefit of all Americans, we must not let this happen. UnidosUS joins with the Congressional Tri-Caucus in urging the Administration to use every tool at its disposal to prevent this potential public health catastrophe," said Janet Murguia, President and CEO, UnidosUS.

"It's imperative that states take the necessary steps to ensure that millions of Americans don't lose their critical health care coverage. Failing to take appropriate action will have devastating impacts on the people who rely on Medicaid for their health care, particularly moms and kids, people of color, rural Americans, and people with disabilities. These risks are particularly acute in states with Republican governors or state legislatures that have refused to expand Medicaid. We support the Tri-Caucus effort and the commitment of the Biden administration to ensure that everyone who is eligible for coverage stays covered," said Leslie Dach, Founder and Chair, Protect Our Care.

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March 17, 2023

To: The Honorable Xavier Becerra Secretary, Department of Health and Human Services 200 Independence Ave., SW, Washington, D.C. 20201

Dear Secretary Becerra:

We, the undersigned members of the Congressional Tri-Caucus - composed of the Congressional Hispanic Caucus, the Congressional Asian Pacific American Caucus, and the Congressional Black Caucus - are deeply concerned that as states and territories begin the process of "unwinding" the Medicaid continuous coverage requirement, millions of low-income individuals - disproportionately people of color/i - are at risk of improperly losing their health insurance. In the Consolidated Appropriations Act, 2023, Congress enacted robust beneficiary protections to prevent improper coverage loss and empowered the Secretary of Health and Human Services (HHS) by providing substantial additional enforcement tools to ensure that states and territories meet their obligations to protect families' health care. During the unwinding, we respectfully request that you prioritize beneficiary access to care and use your new authority to prevent eligible Medicaid families from losing health coverage.

At the beginning of the COVID-19 pandemic, Congress passed legislation to provide additional financial resources to state and territory Medicaid programs and to protect access to health insurance for vulnerable, low- income people. These continuous coverage protections essentially ensured that no one could be disenrolled from Medicaid during the public health emergency. As a result, more than 90 million low-income people are now enrolled in Medicaid and CHIP. This coverage has guaranteed these beneficiaries access to quality, affordable health insurance during the pandemic's peak. However, as states and territories conduct eligibility redeterminations and begin terminating families for the first time in three years, essential coverage could be jeopardized for millions of still-eligible individuals.

An August 2022 report by the Assistant Secretary for Planning and Evaluation (ASPE) estimates that 15 million people will lose Medicaid if the program operates as it did in the past,/ii including nearly 5 million Latinos, more than 2 million African Americans, and nearly 1 million Asian Americans and Pacific Islanders. Already deep health disparities will worsen, due to preventable losses in health coverage. More than half of the people of color and three-fourths of the children whom ASPE projects to lose coverage will remain eligible for Medicaid but be terminated procedurally, because of state and territory administrative burdens.

To prevent a major civil rights and health equity disaster, we believe that you should set the bar high in clearly defining and enforcing states' and territories' legal obligations to prevent eligible beneficiaries from losing coverage. Such clarity will give states and territories strong new incentives for improving their policies to better protect eligible families.

Specifically, we encourage you to consider an approach to enforcement that preserves Medicaid coverage as continuous coverage requirements end. Since significant Medicaid terminations may occur during the unwinding's initial months, rapid mitigation measures must feature robust beneficiary protections--especially an immediate halt to procedural terminations whenever needed to prevent beneficiaries from losing coverage due to potential state legal violations. As mitigation efforts begin in a state or a territory, we also encourage you to consider the simultaneous initiation of the corrective action plan process, so that if mitigation fails, CMS can protect families by swiftly pivoting to enforcement.

In your communications with states and territories, we believe it will be most helpful to emphasize two core legal obligations to prevent a new epidemic of paperwork-driven terminations:

* The duty to base renewals on data matches, rather than paperwork demanded of families, to the "maximum extent practicable."/iii A state or territory violates this obligation if it has many fewer such renewals than other, similarly situated states or territories./iv According to leading experts, "Increasing the proportion of renewals that a state conducts electronically -- without sending paperwork to beneficiaries -- will likely be the most important single step states and territories and CMS can take to avoid coverage losses."/v

* The duty to avoid disparate, adverse impact on communities of color in redetermining Medicaid eligibility./vi This obligation supplements those under Medicaid statutes and regulations. It requires:

- Ensuring that call centers have sufficient staffing so that families are not forced to wait for hours to provide information about their address or eligibility. Families of color disproportionately need fully accessible call centers, as they face barriers to providing information on-line and in-person. Compared to others, people of color are less likely to have broadband access,/vii internet facility,/viii and jobs that provide time off to meet with Medicaid staff./ix

- Ensuring full linguistic access when families respond to state and territory requests for information. This includes providing skilled, professional translation services in call centers and state and territory offices.

- Using all available methods to update addresses so state and territory information requests reach their intended recipients. Anything less than the most robust possible approach will take a disproportionate toll in communities of color. That is because families of color are more likely than non-Hispanic, White families to have changed addresses during the pandemic./x

- Empowering trusted community groups, managed care organizations, and essential community providers to help the greatest possible number of beneficiaries complete any paperwork needed to retain coverage.

- Ensuring that states and territories fully consult and confer with Indian Health Program and Urban Indian Organizations, as early during the unwinding process as possible./xi

To promote transparency and accountability, we believe CMS should provide state and territory performance data to the public and to Congress as soon as possible after the end of each month. Without rapid publication, it may be impossible to intervene in time to prevent significant coverage losses. Further, we recommend that each state and territory should be required to report all redetermination outcomes by race, ethnicity, and age, at the earliest feasible date. Finally, we believe that CMS should use its authority under the CAA to require each state and territory to publish its unwinding and mitigation plans./xii

As you continue defining your approach to implementing the CAA, we respectfully request that you act boldly to protect health care access for tens of millions of low-income, vulnerable individuals. To continue this Administration's legacy of expanded access to care, we know that you will do everything possible to clearly inform states and territories about their legal duties and, whenever necessary to protect struggling families, to swiftly impose powerful mitigation measures and take a strong enforcement posture. Please let us know if there's anything we can do to support you in that effort.

Sincerely,

View co-signers here: https://barragan.house.gov/wp-content/uploads/2023/03/Tri-Caucus-Letter-to-HHS-Secretary-Becerra-to-Protect-Health-Care-Access-and-Preserve-Coverage-During-Medicaid-Unwinding11.pdf

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Original text here: https://www.protectourcare.org/representatives-barragan-chu-horsford-call-for-immediate-action-to-keep-people-covered-as-medicaid-continuous-coverage-requirement-ends/