Sununu Calls for COVID Policy's End

Since the COVID-19 pandemic began, Medicaid recipients have benefitted from a key safeguard: They can't be kicked off the program as long as the federal government continues its public health emergency.

That provision – passed by Congress in March 2020 – has allowed Medicaid recipients to continue receiving that health coverage even if their salary changes or they age out of the program. Before COVID-19, Medicaid beneficiaries were required to renew every year.

But that public health emergency is expected to end soon, and as many as 69,174 Granite Staters are at risk of losing Medicaid health coverage if they don't take action, state officials warn.

The public health emergency is expected to be extended by President Joe Biden at least until April, and possibly later if renewed again. But Gov. Chris Sununu is pressing the Biden administration to end it then. On Monday, Sununu and 24 other Republican state governors urged the Biden administration to end the public health emergency in April, arguing the continuous Medicaid coverage has "artificially" expanded the number of Medicaid recipients and proven too costly to states to continue.

"We urge you to end the national emergency and the (public health emergency) in April and provide states notice of those intentions well in advance to allow us to adequately plan for the future," the governors wrote.

It is unclear when the Medicaid policy will ultimately end; the Biden administration has not announced how long it plans to keep extending the national emergency. But staff members in the Medicaid unit of the Department of Health and Human Services have been working since 2020 to reach out to Medicaid recipients to prepare them – and prevent tens of thousands from potentially losing coverage.

New Hampshire has 100,481 people who risk losing Medicaid as of December, 69,174 of whom have not renewed their eligibility, according to the state's Department of Health and Human Services. Those people could be disenrolled in April if Biden declines to renew the public health emergency program past that date, unless they take action to either renew their Medicaid eligibility or find other coverage.

The state estimates that 35,000 children are also at risk of losing care as well if their parents do not take action, DHHS spokesman Jake Leon said Tuesday.

Not all of the 69,174 people who have not yet reapplied for Medicaid eligibility will be able to do so; that population likely includes people who are no longer eligible due to their age or increased income level, officials say. It is unknown how many people that applies to in New Hampshire.

But stakeholders are racing to get in touch with all of those affected nonetheless. Those who are no longer eligible for Medicaid can be directed to buy subsidized plans on the individual marketplace, either during the standard enrollment period, which ends Jan. 15, or during a special enrollment period they qualify for if they lose their Medicaid coverage. Those who are still eligible for Medicaid can simply reapply.

"We are reaching out to every family that we possibly can," said Lucy Hodder, a law professor at the University of New Hampshire and the director of the Health Law and Policy program.

A major enrollment increase

According to Sununu and the other Republican governors, the Biden administration needs to end the Medicaid coverage safeguard because the measure has run its course and become too expensive.

Created as part of the Families First Coronavirus Response Act in March 2020, the continuous coverage requirement came as part of a deal. The federal government would boost its traditional Medicaid reimbursements to states by 6.2 percent – a helpful assist at a time when unemployment soared and many people lost health insurance. In return, states could not remove anyone from coverage for the duration of the emergency.

Like other states, New Hampshire's Medicaid program enrollment increased significantly. There are 69,980 more people in the Granite State on Medicaid in December 2022 than there were in March 2020, a 39.4 percent increase in nearly three years.

Meanwhile, the federal state of emergency has been continually renewed in three-month increments, allowing people to remain Medicaid even if they no longer qualify. The latest renewal will expire on Jan 11. But the Biden administration has promised states at least a 60-day notice before it decides to end the pandemic status, and because the White House has not given that notice, states are assuming it will be renewed at least another 90 days, until April.

The Republican governors argued that the continuous coverage requirement "is costing states hundreds of millions of dollars." In New Hampshire, the cost of that specific requirement is difficult to quantify. The increased numbers include people in both traditional Medicaid and Medicaid expansion, each of which receive different reimbursements rates from the federal government. And it is unclear how many Granite Staters are currently on Medicaid but would not be eligible if the continuous coverage requirement ended.

But the overall cost of Medicaid in New Hampshire has increased. On Wednesday, the Executive Council will take up a $245 million increase to the state's five-year contract with the organizations that run Medicare, of which $46.5 million is coming from state funds and the remainder from federal funds. That jump represents a 5.6 percent increase to the overall, five-year contract.

In their letter, the governors argued that the end of the widespread COVID-19 mitigation efforts are another jusitication for ending federal public health emergency. "While the enhanced federal match provides some assistance to blunt the increasing costs due to higher enrollment numbers in our Medicaid programs, states are required to increase our non-federal match to adequately cover all enrollees and cannot disenroll members from the program unless they do so voluntarily," they wrote.

Hodder declined to comment on the governor's letter, but praised the Medicaid continuous coverage policy in general, which she called "incredibly important to the people of New Hampshire."

But she agreed that the Biden administration should give advance notice whenever it does decide to end the protections so that states and advocates can prepare.

"It would be helpful to know and to have a long glide path to that date," she said.

Efforts ongoing to reach families

Regardless of when the coverage safeguards end, state employees and advocates are working side by side to keep people informed and insured.

At the Department of Health and Human Services, that work has continued since July 2020, Leon said. But it became urgent in recent months as the program appeared close to the end.

The department has deployed 30 additional staff members to reach out to recipients who are due for a Medicaid renewal by phone, and those employees have made 41,000 calls since July 2020, 3,000 of which were follow-up conversations. It has employed a "pink letter" campaign to send eye-catching, pink notices by mail to people who need to renew. And it has partnered with other state agencies and organizations, according to Leon.

The result: 22,269 people have completed renewals so far, while 69,174 have not, Leon said Tuesday.

DHHS has worked with the Insurance Department to connect people to insurance navigators to bring them onto the individual market if they no longer qualify for Medicaid. It has collaborated with the Department of Education on back-to-school messages to reach parents whose kids could lose health coverage if they do not reapply for eligibility. And the managed care organizations themselves – which run the Medicaid program – have been carrying out their own outreach.

Hodder and her colleague Deborah Fournier, a senior associate of health law and policy at the Institute for Health Policy and Practice at UNH, have launched their own effort. The two lead a team that has leveraged social media, health care providers, insurance navigators, and community members to try to spread the word about the need to re-enroll.

Those who need to renew coverage should go to nheasy.nh.gov, a portal run by DHHS that provides assistance. They can also call 1-844-275-3447.

New Hampshire's enrollment period for the individual market ends on Jan. 15. But if a person is no longer eligible for Medicaid in April and loses coverage, they can apply for a special enrollment period and join an individual market plan after the normal deadline, Hodder noted.

"We are going to do everything possible … to make sure no matter why you lose Medicaid, or how you lose Medicaid – voluntarily, involuntarily – you have access to the marketplace," Hodder said.