Adam Sparks earns $13 an hour as an assistant director at a movie theater in suburban Des Moines, Iowa. That’s enough for the 24-year-old to pay for most necessities except healthcare.
He relies on Medicaid to cover allergy medications, his recently diagnosed attention deficit/hyperactivity disorder, and doctor visits and therapy sessions. But he and millions of other Americans may soon be faced with a dilemma.
Modest increases in his part-time employment pushed him over the eligibility threshold for the government’s health insurance program for low-income residents. He stayed on Medicaid only because the federal government provided robust federal aid to states on the condition that they did not take people off Medicaid until the COVID-19 public health emergency was over.
What was initially seen by Congress and public health experts as a temporary measure to maintain health coverage during a century-long pandemic dragged on for more than two years, with Medicaid enrollments hitting 78.9 million in November, most recent. figures available.
Now the public health emergency is due to expire on April 16. A report by the Urban Institute estimates that up to 12.9 million Americans could lose Medicaid if the public health emergency is not prolonged.
An end to the emergency would also ripple through other pockets of the healthcare industry. Federal agencies have created temporary initiatives to subsidize private health insurance, improve access to telehealth, provide additional funding to hospitals and make it easier for companies that make medical devices, tests and treatments to put their products on the market in an emergency.
US Department of Health and Human Services Secretary Xavier Becerra has not announced a decision on whether to extend the public health emergency, although there are reasons to believe he will. will do. HHS has extended the emergency every 90 days, and an HHS official said the agency will notify states 60 days before ending the emergency. Barely two weeks before the next deadline, this notification has not taken place.
Whenever the health emergency ends, running these programs will create a massive logistical task for the Biden administration. Nowhere is the potential disruption more evident than for the millions of people who could lose their Medicaid coverage.
Sparks said his coverage has helped him take care of his medical needs while trying to improve his outlook. His long term goal is to work on film editing, and he is spending time learning the craft. He would like to land a job as a video editor at a local TV news station, but fears that losing his health insurance will be another obstacle to furthering his career.
“I don’t make a lot of money and I find it difficult to improve my situation as much as possible,” he said. “It definitely doesn’t help me. It causes major stress and anxiety.”
States are making plans and tackling a huge task ahead
At the end of the emergency, state Medicaid agencies will have 12 months to verify each person’s eligibility and notify them if they are no longer eligible. This massive task is unlike anything state Medicaid programs have undertaken at one time, experts say.
“It’s definitely the number one issue on our members’ priority list,” said Jack Rollins, director of federal policy for the National Association of Medicaid Administrators.
Rollins said it typically takes two to three months to complete an eligibility check, and many states are now preparing by verifying mailing addresses and verifying members’ cell numbers to ensure they have the necessary credentials. correct coordinates.
This is a monumental task for states, many of which have fewer workers to manage these controls than at the start of the pandemic. Some states have downsized and others are having to hire workers or hire contractors to replace those who have retired or resigned.
A Kaiser Family Foundation survey released in March found that 27 states had a plan for how to meet the challenge of resuming eligibility checks. The survey found that 11 states would first target enrollees who appeared to no longer be eligible; nine states plan to wait until the individual’s annual renewal is due.
Iowa’s state Medicaid agency has continued monthly eligibility checks during the pandemic and does not anticipate any major issues when the emergency ends, according to Department of Human Services spokesperson Alex Carfrae.
The agency will also work with navigators to help Medicaid dropouts find other insurance options, including the Affordable Care Act market or Medicare.
After his last pay raise, Sparks called Iowa’s Medicaid agency because he didn’t want to break the program’s rules. A representative from the Iowa Department of Social Services told him he might no longer qualify but would not be fired immediately, Sparks said.
“I’m just trying to be responsible,” Sparks said. “Now I feel like it’s almost a punishment because they’re telling me I’m potentially going to lose my confidence.”
Medicaid policy could be a factor
Some states might be motivated to ramp up checks because of political opposition to Medicaid expansion or because the federal government will end additional matching funding three months after the emergency ends. That would let states pay a bigger chunk for each Medicaid enrollee, which could squeeze state budgets.
“They think if they could reduce their workload faster, they would save money,” said Leighton Ku, a George Washington University professor and director of the Center for Health Policy Research at Milken. Institute School of Public Health.
But states looking to get rid of Medicaid enrollees quickly could hurt their economies in the long run, according to an analysis co-authored by Ku.
States could save $3 billion on their share of the Medicaid bill if they removed ineligible people in six months instead of 12 months, the analysis showed. But by leaving so many residents uninsured, states could lose more than half a million jobs and $54 billion in economic output.
For states that maintain longer coverage, “more money ends up flowing into the state and helps ensure that hospitals and doctor’s offices have money to pay their staff,” Ku said.
Some analysts worry that states that choose to fast-track Medicaid will make mistakes and remove people who are still eligible.
The Urban Institute has warned that the high volume of eligibility checks raises concerns that people could be wrongfully removed from the lists. Another risk: people who are no longer insured might not know that they might be eligible for other programs. Some families might be eligible for the Children’s Health Insurance program or subsidized coverage through the Affordable Care Act market, said Matthew Buettgens, principal investigator at the Urban Institute.
The federal government has encouraged states to coordinate with community organizations to educate people at risk of losing coverage, but it’s not a requirement. “Different states are likely to do different things,” Buettgens said.
In Florida, community groups say the state has said little about how quickly it plans to de-enroll beneficiaries.
Many Florida residents on Medicaid have been confused about how the pandemic has allowed them to maintain coverage and may be surprised when eligibility checks resume, said Jodi Ray, director of Florida Covering Kids & Families, a organization at the University of South Florida that works with state agencies. and community actors to ensure residents have access to health insurance.
“When people are looking for help and they can’t talk to someone, they’re going to turn to people on the ground who know how to navigate these programs,” Ray said. “We want to make sure people don’t fall through the cracks.”
One in four Americans is covered by Medicaid or CHIP, a program that insures low-income children
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Quote: Millions Could Lose Health Insurance Coverage When COVID-19 Emergency Ends (April 1, 2022) Retrieved April 2, 2022 from https://medicalxpress.com/news/2022-04-millions- people-health-coverage-covid-.html
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