State officials want more time and predictability from the Biden administration before the end of the COVID-19 public health emergency and with it a massive undertaking to redetermine eligibility for Medicaid coverage.
Several state officials and advocates discussed their current preparations for the end of the PHE during a Thursday meeting of the Medicaid and Children’s Health Insurance Program (CHIP) Payment and Access Commission, which advises Congress on Medicaid and CHIP issues. The remarks come a week after the Department of Health and Human Services (HHS) extended the PHE until April.
“The No. 1 question I’ve asked every single day … is when will this PHE end?” said Jeff Nelson, director of the CHIP Program and bureau of eligibility policy for the Utah Department of Health.
The federal government allowed states to not drop beneficiaries off Medicaid in exchange for a 6.2% increase in the federal matching rate for payments.
States could not drop off any enrollees for the duration of the PHE, which started in February 2020 and was recently extended through April by HHS Secretary Xavier Becerra two days before it expired. However, it could be delayed even further.
If the PHE is “going to be extended again, though, we need to know what that looks like,” said Jeremy Vandehey, director of health policy and analytics division for the Oregon Health Authority. “Getting an extension two days before is really disruptive. We would love to have as much time as possible.”
State officials say they are trying to get their systems ready to redetermine eligibility for everyone on Medicaid.
Vandehey said his state is working on how to transition Medicaid enrollees over to the state’s Affordable Care Act exchange.
“There is no way to do an easy data exchange or automatically enroll folks,” he said. “We can largely determine if they will be eligible for Medicaid or not, but then we have to do a data handoff to our marketplace team. They will have to do manual outreach.”
Making sure beneficiaries’ addresses and contact information are up to date is critical for states, Nelson said.
Last year, the Centers for Medicare & Medicaid Services (CMS) announced that states have 12 months from the end of the health emergency to finish eligibility redeterminations, an increase from the previous deadline of six months.
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But some states may force officials to finish the redeterminations even earlier. Nelson said he is working with his state’s legislature to ensure he gets the full year.
He is also looking to prioritize redeterminations to focus primarily on the people the state knows are ineligible for Medicaid or will be moving from one program to another like CHIP.
Even though CMS extended the deadline from six months to a year, states say they need much more predictability on when the PHE is going to end so they are ready for the undertaking of reviewing the beneficiaries.
CMS will give states a 60-day notice that the PHE will not be extended again, but Nelson said it would be helpful to get even more time.
“I would prefer six months,” he said.
States could get some help from Congress. The Build Back Better Act, a massive $1.75 trillion social spending package, included legislation to decouple the continuous coverage requirement from the health emergency to give states a glide path for resuming redeterminations.
However, even though that legislation has passed the House, it is likely doomed in the Senate. President Joe Biden expressed an interest in splitting the package into larger pieces that can be signed into law, but it remains unclear what health policies could survive that move.