Section 319 of the Public Health Service Act gives the federal HHS Secretary the authority to make such a declaration when a severe disease . CMS has issued specific guidance allowing states to permit MCOs to update enrollee contact information and facilitate continued enrollment. Prescribed Pediatric Extended Care services by 15% effective October 1, 2022 through the end of the public health emergency. If youve recently submitted renewal information to your state and its clear that youre still eligible, your coverage will continue as usual until your next renewal period. As a result, in order for these waivers to continue, Congress must act and pass legislation making these waivers permanent. (Prior to the pandemic, states had to recheck each enrollees eligibility at least once per year, and disenroll people who were no longer eligible. Even though Congress could still enact some version of the BBB provisions relating to the unwinding of the continuous enrollment requirement, some states would find an April 1, 2022 renewal start date challenging. Many of these waivers and broad . b1Y nact1X i"hi9!0 "@,f W1LL\vL1.ez,t_M8cp]4XfiFfm m2=sX1g`Vw? How the COVID relief law will rescue marketplace plan buyers, If you have access to an employer-sponsored health plan, your loss of Medicaid coverage will trigger a special enrollment period that will allow you to enroll in the employer-sponsored plan. Read about your data and privacy. A recent analysis of churn rates among children found that while churn rates increased among children of all racial and ethnic groups, the increase was largest for Hispanic children, suggesting they face greater barriers to maintaining coverage. Some have described this as the single largest enrollment event since the Affordable Care Act. during which you can transition to Medicare without any late enrollment penalties. Additionally, people with LEP and people with disabilities are more likely to encounter challenges due to language and other barriers accessing information in needed formats. These reporting requirements were part of a broad set of CMS guidance documents issued over the past several months. And although the Biden administration had promised states at least a 60-day notice before the end of the PHE, states had noted that it was still proving very difficult to plan for the resumption of Medicaid eligibility redeterminations given the uncertain timeframe. In 2020, one in ten Medicaid enrollees moved in-state and while shares of Medicaid enrollees moving within a state has trended downward in recent years, those trends could have changed in 2021 and 2022. However, while the new data reporting requirements are useful, they will not provide a complete picture of how the unwinding is proceeding and whether certain groups face barriers to maintaining coverage. HHS has laid out some basic guidelines, and states have four general options in terms of how they handle the unwinding of the continuous coverage protocols and the return to regular eligibility redeterminations for the entire Medicaid population: If youre still eligible for Medicaid under your states rules, youll be able to keep your coverage. Medicaid is a prime example: As of late 2022, enrollment in Medicaid/CHIP stood at nearly 91 million people, with more than 19 million new enrollees since early 2020. Starting April 1, 2023, states can resume Medicaid disenrollments. Under the Consolidation Appropriations Act, 2023, the resumption of Medicaid disenrollments is no longer linked to the end of the COVID public health emergency. Preparing for the End of COVID-19: Return to Regular Renewals . This brief describes 10 key points about the unwinding of the Medicaid continuous enrollment requirement, highlighting data and analyses that can inform the unwinding process as well as recent legislation and guidance issued by the Centers for Medicare and Medicaid Services (CMS) to help states prepare for the end of the continuous enrollment provision. That's at least in part due to 2020's Families First Coronavirus Response Act, which required state Medicaid programs to keep beneficiaries enrolled through the duration of the pandemic. If you no longer meet your states Medicaid eligibility guidelines, its a good idea to understand what your options will be when your state begins disenrolling people who are no longer eligible. Efforts to conduct outreach, education and provide enrollment assistance can help ensure that those who remain eligible for Medicaid are able to retain coverage and those who are no longer eligible can transition to other sources of coverage. 0 Most of the people who will become eligible for marketplace subsidies will be adults, as children are always much less likely than adults to qualify for marketplace subsidies. (Note that there are several terms that are used interchangeably: Eligibility redetermination, renewal, case review, recertification, and redetermination all mean the same thing, and refer to the process by which the state determines whether a Medicaid enrollee is eligible to continue to receive Medicaid.). The main point to keep in mind is that the opportunity to transition to new coverage, from an employer, Medicare, or through the marketplace, is time-limited, although the unwinding SEP described above (announced in late January 2023) gives people significantly more flexibility in terms of being able to enroll in a plan through HealthCare.gov after losing Medicaid during the 16-month window that starts March 31, 2023. For everyone enrolled in Medicaid as of March 31, 2023, states must initiate the renewal process no later than March 31, 2024. The ARP is still making premiums more affordable. If you dont have access to an employer-sponsored plan and you are eligible for marketplace subsidies (most people are), the best course of action is to enroll in a marketplace plan as soon as you know that your Medicaid coverage will be terminated, in order to avoid or minimize a gap in coverage. Eligible individuals are at risk for losing coverage if they do not receive or understand notices or forms requesting additional information to verify eligibility or do not respond to requests within required timeframes. However, there will also be current enrollees who are determined to be no longer be eligible for Medicaid, but who may be eligible for ACA marketplace or other coverage. HHS says it plans to extend Covid-19 public health emergency - POLITICO Health Care HHS says it plans to extend Covid-19 public health emergency An extension would ensure expanded. Another analysis examining a cohort of children newly enrolled in Medicaid in July 2017 found that churn rates more than doubled following annual renewal, signaling that many eligible children lose coverage at renewal. And since coverage cannot be backdated, its essential to ensure that youre covered before any medical needs arise. This should include an email address and cell phone number if you have them, as states are increasingly using email and text messages, as well as regular mail, to contact enrollees. NOTE: States may not elect a period longer than the Presidential or Secretarial emergency declaration . The law also prohibits states from disenrolling a person simply based on undelivered mail. ANA has worked with the Department of Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS) on making waivers permanent, but CMS believes that they do not have the authority to make any additional waivers permanent. But the Consolidated Appropriations Act, 2023 ensures that states continue to receive at least some additional federal Medicaid funding throughout 2023. The public health emergency, first declared in January 2020 by the Trump administration, has been renewed every 90 days since the pandemic began. If providers finish submitting their evidence by that date, then the Department would be in a position to verify the evidence and confirm compliance in early 2023. This JAMA Forum discusses the potential ramifications after the COVID-19 public health emergency ends such as limiting telehealth, ending the continuous enrollment requirement in Medicaid, and decreasing regulatory flexibility that has allowed pharmacists to administer COVID-19 vaccines. As COVID-19 becomes less of a threat and the federal government's public health emergency ends, states will restart yearly Medicaid and Children's Health Insurance Program (CHIP) eligibility reviews beginning April 1, 2023. The PHE will probably be extended through the first half of 2022, and further extension is possible. This provision requires 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. The Consolidated Appropriations Act, 2023 decouples the Medicaid continuous enrollment provision from the PHE and terminates this provision on March 31, 2023. But the overall pace of Medicaid eligibility redeterminations and disenrollments will vary considerably from one state to another. While nearly all states accept information by mail and in person, slightly fewer provide options for individuals to submit information over the phone (39 states) or through online accounts (41 states). But the continued enrollment growth in Medicaid is primarily due to the fact that the Families First Coronavirus Response Act (FFCRA), enacted in March 2020, has been providing states with additional federal funding for their Medicaid programs, as long as they dont disenroll people from Medicaid during the COVID public health emergency (PHE) period. October 17, 2022. Also fueling Democrats shift: pressure from state health officials who have been lobbying Congress to give them a set date when their Covid posture will formally end after years of last-minute extensions from the White House. At the start of the pandemic, Congress enacted the Families First Coronavirus Response Act (FFCRA), which included a requirement that Medicaid programs keep people continuously enrolled through the end of the month in which the COVID-19 public health emergency (PHE) ends, in exchange for enhanced federal funding. The share of people who lack health insurance coverage dropped to 8.6% in 2021, matching the historic low in 2016, largely because of increases in Medicaid coverage, and to a lesser extent, increases in Marketplace coverage. %PDF-1.6 % An analysis of state Medicaid websites found that while a majority of states translate their online application landing page or PDF application into other languages, most only provide Spanish translations (Figure 7). (Be prepared to provide proof of your ongoing eligibility under your states Medicaid rules.). (Note that the Biden administration has implemented a fix for the family glitch, making some employees family members newly eligible for marketplace subsidies in 2023 even with an offer of employer-sponsored coverage.). Can I use my Medicaid coverage in any state? In addition, Executive Order 84 allowed for certain additional state flexibilities under a new, temporary state PHE. This window, If you do not have access to an employer-sponsored health plan, you can apply for a premium tax credit (subsidy) to offset the cost of coverage in the, The subsidies that are currently available in the marketplace are particularly generous, thanks to the, If youre in a state that hasnt expanded Medicaid under the ACA and your income is below the poverty level, you may find yourself in the. This will be the case, for example, for someone who was enrolled under Medicaid expansion guidelines (which only apply through age 64) and has turned 65 during the PHE. By preventing states from disenrolling people from coverage, the continuous enrollment provision has helped to preserve coverage during the pandemic. President Biden says the emergency order will expire May 11. Your email address will not be published. %PDF-1.7 % The continuous coverage provision increased state spending for Medicaid, though KFF has estimated that the enhanced federal funding from a 6.2 percentage point increase in the federal match rate (FMAP) exceeded the higher state costs. Together, these findings suggest that individuals face barriers moving from Medicaid to other coverage programs, including S-CHIP. Note: This brief was updated Feb. 22, 2023, to include more recent and additional data. Some states suspended renewals as they implemented the continuous enrollment provision and made other COVID-related adjustments to operations. But enrollment has trended upward throughout the pandemic, without the normal disenrollments that previously stemmed from the regular Medicaid eligibility redetermination process. 2716, the Consolidated Appropriations Act (CAA) for Fiscal Year 2023. HHS projects that approximately 15 million people will lose eligibility for Medicaid once the normal eligibility redetermination process resumes. 3179 0 obj <>/Filter/FlateDecode/ID[<20F5AF77DB63DC49B2341D6107722670>]/Index[3168 23]/Info 3167 0 R/Length 69/Prev 482993/Root 3169 0 R/Size 3191/Type/XRef/W[1 2 1]>>stream If youre currently enrolled in Medicaid, its a good idea to familiarize yourself with your states eligibility rules, and figure out whether youd be eligible if you were to apply today, with your current circumstances and income. uyx'tE!~YV.v.wDO @:Z98-PtinB*[Elrcr[b8B9NX5IR'[UC.ok"zf3itMAiP((ISh. Or maybe your circumstances have changed perhaps your income is the same but you have fewer people in your household and your income now puts you at a higher percentage of the poverty level. The Centers for Medicare & Medicaid Services (CMS) has released numerous guidance documents and tools designed to help states. The COVID-19 Public Health Emergency (PHE) that was declared in March 2020 is set to end on May 11, 2023, as the President has announced there will be no more extensions to the PHE. | T p{YWY4,;U|p9 Other than that, if you miss the special enrollment period for your particular coverage, youll have to wait until the next annual open enrollment period to sign up for coverage (employers set their own annual enrollment windows; Medicares general enrollment period is January March each year). hb```+@(1IAcfK9[<6k`cts``NaPsg@uQVH(pGS 4)NtQlqV~T~(plUUv=@\8\:\4?LqB d The latest extension will expire on April 16, 2022. The Consolidated Appropriations Act, 2023 (enacted in December 2022) has given states a specific date April 1, 2023 when they can begin terminating coverage for enrollees who are no longer eligible. Congressional negotiators are set to unveil the text of the 2023 omnibus spending bill on Monday. 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