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10 Things To Know About The Unwinding Of Medicaid
  • Posted On: March 9, 2023
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10 Things To Know About The Unwinding Of Medicaid

Medicaid provides coverage to a large portion of the US population, including seniors, disabled, and pregnant women, however, income limits vary per state and the eligibility group.

Millions could lose their Medicaid benefits by April 2023 as pandemic rules ease. Starting April 1, 2023, states can begin shedding their Medicaid rolls of people who no longer qualify, under the spending bill passed by Congress in December 2022. Low-income people could be in crisis when the public health emergency (PHE) ends.

The US Department of Health and Human Services (HHS) has estimated that about 15 million people are at risk of losing their Medicaid coverage. HHS also estimates that about 7 million out of the estimated 15 million at risk might lose coverage due to bureaucratic snafus or procedural snags, like changes in contact information. Some states are more eager to shed recipients than others, while the US Centers for Medicare and Medicaid Services (CMS) requires that before anyone is terminated from coverage, the state has to do a full redetermination of eligibility for that individual. However, states that are more supportive of Medicaid might ease the process for program members. For example, in Ohio, the estimate from the actuary for the Joint Medicaid Oversight Committee says that 24.5% of the COVID-driven enrollment gains will be disenrolled by 2024. That means, nearly 200, 000 Ohioans are likely to lose Medicaid benefits when the public health emergency ends.

When the continuous enrollment provision ends and states resume redeterminations of the eligible beneficiaries, certain individuals might be at an increased risk of losing Medicaid coverage, thus facing gaps in coverage. A failure to respond can result in loss of coverage.

Here are 10 things that you should know about the unwinding process:

1 The Consolidated Appropriations Act 2023 decoupled the Medicaid continuous enrollment provision from the PHE and terminates this provision on March 31, 2023. States can resume Medicaid disenrollments, and phase down enhanced FMAP if they comply with certain rules.

2 It is estimated that a 5% decline in total enrollments and a 13% decline in enrollment will result in between 5.5 million to 14.2 million people losing coverage during the 12-month unwinding period.

3  There could be temporary loss of Medicaid coverage due to reasons like short-term changes in income or circumstances, not understanding notices and forms requesting additional information, etc. An estimate shows that among full-benefit beneficiaries enrolled in 2018, 10.3% had a gap in coverage of less than a year.

4 CMS requires states to develop operational plans for the unwinding process, that should describe priority renewals, and strategies to reduce inappropriate coverage loss during the unwinding process.

5 Under the Affordable Care Act (ACA), states are required to seek complete administrative renewals by verifying ongoing eligibility through available data sources, before sending a renewal form from an enrollee.

6 To reduce administrative burden, CMS has announced the waiver that will be available on a time-limited basis and will enable states to facilitate the renewal process for certain enrollees, to minimize procedural terminations.

7 When the continuous enrollment provision ends, certain individuals will be at an increased risk of losing Medicaid coverage or experiencing a gap due to barriers in the renewal process.

8 States can collaborate with health plans and community organizations at the continuous enrollment provisions to conduct outreach to endless about the need to complete their annual renewal during the unwinding period.

9 For system readiness reporting, states are required to demonstrate their eligibility systems for processing renewals, as they have not been conducting normal renewals during the continuous enrollment period.

10 CMS has issued guidelines to states to streamline processes and implement other strategies to reduce the number of people losing coverage despite their eligibility.

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10 Things To Know About The Unwinding Of Medicaid

Disclaimer: The information and content posted on this website is intended for informational purposes only and is not intended to be used as a replacement for medical advice. Always seek medical advice from a medical professional for diagnosis or treatment, including before embarking on and/or changing any prescription medication or for specific medical advice related to your medical history.

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