Summary: With federal protections for Medicaid coverage during the public health emergency winding down, states are aiming for an orderly “redetermination” process. Translation: orderly ousting from public insurance. About 1 in 8 individuals with Medicaid coverage will lose it, up to 1 in 3 in some states, often due to process problems. This is a double whammy – administrative burden that worsens access to care. Instead, we need lifelong, universal, equitable coverage.
Medicaid and CHIP Eligibility and Enrollment Policies as of January 2022: Findings from a 50-State Survey, Kaiser Family Foundation, March 16, 2022, by Tricia Brooks et al.
Executive Summary: Enrollment in Medicaid has grown significantly during the coronavirus pandemic. Provisions in the Families First Coronavirus Response Act (FFCRA) require states to provide continuous coverage for Medicaid enrollees until the end of the month in which the public health emergency (PHE) ends in order to receive enhanced federal funding. Continuous enrollment has helped to preserve coverage and halted Medicaid churn. However, when the PHE ends, states will begin processing redeterminations and millions of people could lose coverage if they are no longer eligible or face administrative barriers despite remaining eligible. Existing state enrollment and renewal procedures, as well as their approaches to the unwinding of the continuous enrollment requirement, will have major implications for Medicaid enrollment and broader coverage. …
In 20 states able to report, it is estimated that about 13% of Medicaid enrollees will be disenrolled when the continuous enrollment requirement ends. However, the estimates range widely across reporting states from about 8% to over 30% of total enrollees. Based on available data, most states report that an increase in income will be the primary reason for the disenrollments, but several states also expect incomplete renewals or missing documentation to be a primary reason for disenrollment. If these estimates hold true, millions of people will lose Medicaid coverage in the months following the end of the PHE; however, many children will likely be eligible for CHIP and many adults will likely be eligible for Marketplace or other coverage. Successfully transitioning these individuals into those other coverage options could reduce the number who lose coverage altogether and become uninsured.
Comment:
By Jim Kahn, M.D., M.P.H.
One thing we did right on health insurance during the COVID pandemic is to provide continuous coverage for Medicaid participants. That is, don’t remove the poor and near-poor from public health insurance during a public health emergency.
Now that the crisis is easing, we can return to business as usual. Which means:
— Spend a huge amount of effort and money to review eligibility, so if someone is again working (often at a low paying job without health insurance), take away their Medicaid.
— In the process, many people who still do qualify for Medicaid will lose coverage for bureaucratic reasons – missed process steps, not lack of eligibility.
— Net effect: reduced access to care and resulting illness, bankruptcies, and deaths.
Why do we torture ourselves with these burdensome and inhumane systems, when we could cover everyone with high quality insurance for their full lifetimes, while saving money?
Our system is operating with cumbersome rules and indefensible values.
The solution is … yes, you guessed it … single payer. Generous, simple, affordable.
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