MACPAC calls for greater transparency from states, CMS in COVID-19 emergency unwinding

A key panel wants greater transparency from federal regulators and states to chart the unwinding of the COVID-19 public health emergency and with it a massive effort to redetermine Medicaid eligibility.

Members of the Medicaid and CHIP Payment and Access Commission (MACPAC) called for the public release of state-issued reports on the unwinding of the PHE. They noted that the data are vital to understand how states are handling the major task of determining who should and should not be on Medicaid.

“I am very concerned about the lack of commitment to data transparency,” said commission member Tricia Brooks with the Georgetown Center for Children and Families. “[The Centers for Medicare & Medicaid Services (CMS)] has said on numerous occasions that they are not going to release the data other than what they are also releasing.”

At the start of the pandemic, the federal government raised the matching rate for Medicaid in exchange for states agreeing to not drop anyone off Medicaid’s rolls for the duration of the PHE. States and CMS have been bracing for the end of the PHE, which was extended again into January but could expire next year. 

States have 14 months after the end of the PHE to redetermine eligibility for its Medicaid beneficiaries and are hiring new staff and resources to prepare. During that tenure, they must give CMS a series of reports on their progress, including monthly reports on the progress of the unwinding. 

However, states are not required to publicly release these data, although seven states have agreed to do that as of September, according to a MACPAC staff presentation

Brooks said the commission doesn’t need “every piece of data, but I do think we need call center stats.”

She added that they also need to know the figure of how many people lost coverage inappropriately, citing a recent Department of Health and Human Services (HHS) report that said 6.8 million people will lose Medicaid coverage during the unwinding even though they are still eligible for coverage. 

That same report noted children and young adults could be especially hit hard by eligibility losses (PDF). 

“Disproportionately, kids are going to be negatively impacted by this,” said Robert Duncan, a commission member with Connecticut Children’s Hospital. “As they are collecting the data, I’d like to see it from an age category so we can call that out.”

CMS has told MACPAC that it will use the data to work with the states to mitigate any issues with the unwinding. 

How the unwinding will take place could have a major impact on Medicaid coverage, which has swelled during the pandemic. HHS’ report predicts 8.2 million people could lose Medicaid coverage due to the loss of eligibility and may need to transition to another coverage source such as the Affordable Care Act exchanges. 

CMS is giving guidance to states, which have sought to shore up staff and infrastructure ahead of the unwinding.