As the nation's continuous Medicaid enrollment policy unwinds, hospitals and health systems are preparing for redeterminations and could encounter millions of newly uninsured patients.
Congress enacted the Families First Coronavirus Response Act in early 2020, which set into motion continuous Medicaid/Children's Health Insurance Program enrollment during the COVID-19 pandemic. States have received increased federal funding in exchange for pausing disenrollments, and under the continuous enrollment provision, Medicaid/CHIP enrollment increased by 21.2 million enrollees, or 29.8 percent, from February 2020 to December 2022. This provision was initially tied to the national COVID-19 public health emergency, which is slated to end May 11. But in December, Congress decoupled the PHE from the continuous enrollment provision, meaning states could resume determining who is and isn't eligible for Medicaid starting April 1.
Now, millions of Americans are slated to lose Medicaid coverage by June 2024. The process will particularly affect states that haven't expanded Medicaid (or states that saw large upticks in enrollment during the pandemic).
Estimates of how many people will be disenrolled from Medicaid vary. HHS estimates around 15 million could lose coverage. An April 26 analysis from Kaiser Family Foundation estimated between 8 million and 24 million people will be disenrolled, based on estimates reported by state agencies.
The Urban Institute and Robert Wood Johnson Foundation predict that Utah will have the highest share of members disenrolled, followed by Indiana. Fourteen states, including Indiana, will see more than 20 percent of their Medicaid beneficiaries lose coverage, according to the analysis.
With this in mind, Becker's reached out to hospitals and health systems in these states to see how they are preparing for redeterminations.
Indianapolis-based Indiana University Health is in an expansion state that the Urban Institute and Robert Wood Johnson Foundation predict will see estimated enrollment drop from 1,897,000 to 1,364,000 by June 2024.
IU Health told Becker's it is providing personal assistance to Medicaid members on how to keep their benefits or find new health coverage.
"Financial counselors are available at all IU Health hospitals and cancer center locations as well as community outreach events, including a free benefits health fair in Indianapolis on April 29," the health system said, adding that the fair is organized by four Indianapolis churches that are partnering to support healthy communities in predominantly Black neighborhoods.
In Florida, K. Scott Wester serves as president and CEO of Hollywood-based Memorial Healthcare System, a public, nonprofit hospital system governed by the South Broward Hospital District Board of Commissioners. He joined the system last year after working in Louisiana, which has expanded Medicaid. Florida has not. The Urban Institute and Robert Wood Johnson Foundation predict that Florida will see about 1 million people disenrolled during the redetermination process.
Mr. Wester told Becker's the Florida Department of Children and Families and the Florida Agency for Health Care Administration have worked to make the process of redeterminations as easy as possible.
"Everybody is trying to collectively figure it out," he said. "If you can auto-enroll someone based on information the state can gather by its systems and through technology, that's the easiest course.
"And it'll be interesting to see what percentage will be auto-reenrolled, and that can be 80 percent, 90 percent [statewide], but it's going to be hopefully above 80 percent."
In January, Florida reported processing between 25 and 50 percent of Medicaid renewals through an automatic "ex parte" process, according to Kaiser Family Foundation.
There are also those who will not be able to auto-reenroll based on income changes or other factors. But, in any circumstance, preparation will be key, according to Mr. Wester.
"As long as individuals do some work or preparation on the front end, it enables it to be a lot easier to see if they're eligible or not eligible," he said.
Meanwhile, Memorial Healthcare System has focused on educating people about the redetermination process and working to assist people with their enrollment package, Mr. Wester said.
"If they're not able to be enrolled, then how do we then help them to look at other alternative coverage? And that's a whole different box of opportunity, too," he said, adding that individuals in that group may be eligible for Medicare or to go on the ACA exchanges.
"Knowing our provider-sponsored network, we'll have good analytics that we'll be able to use from a health plan perspective. But then our teams will be organizing to see if we can do as much of it [as possible] when people actually present themselves for some level of clinical care."
Still, Mr. Wester acknowledged that redeterminations will be a long-term process involving various groups over the next couple of quarters.
"Every state is going to go through this process," he said. "I've been very impressed with how Florida is doing this, and I think as much as they can to make this as easy as possible for such a large group of individuals. For organizations like Memorial Healthcare System, we'll work very closely with those individuals when they come for care. And we'll take care of anybody who needs to be taken care of. That's part of who we are and our mission and our values of what we do in this community. And hopefully we'll be able to provide additional resources if individuals need that."
Sioux Falls, S.D.-based Sanford Health has been preparing for the end of Medicaid continuous coverage almost since the beginning of the COVID-19 public health emergency, Martha Leclerc, vice president of corporate contracting, told Becker's.
The system operates 300-plus locations across Minnesota, North Dakota and South Dakota. Around 1 in 4 Medicaid recipients in Minnesota and North Dakota could lose coverage, according to the Urban Institute's estimates.
Sanford Health's service area includes some of the lowest-income counties in the U.S., Ms. Leclerc said, with patients spread across thousands of miles.
"It is a big challenge for us to make sure that we are connecting with our patients and making sure they know what their options are," Ms. Leclerc said. "Because, in the end, if they lose their coverage, they are not likely to come in for preventive care, their diagnosis progresses, it gets worse, and in the end, it will cost more to the system, to the state, and it will result in worse health outcomes."
Tony Morrison, vice president of revenue cycle at Sanford Health, said the system has around 226,000 Medicaid-covered lives.
"Whether it's from the time they call and inquire about an appointment, when they make the appointment, when we start the pre-registration process, all the way until they show up at our door, we're going to check that eligibility because we don't know where in that process the patient is going to have to go in and get that done."
Eric Dickson, MD, serves as president and CEO of Worcester, Mass.-based UMass Memorial Health and board chair of America's Essential Hospitals, which represents safety-net facilities.
With Massachusetts being an expansion state, UMass Memorial Health has always made significant efforts toward Medicaid enrollment, said Dr. Dickson. Now those efforts will intensify during the redetermination process.
"We have to be prepared that more people are going to be coming into the emergency department, to the clinic having lost their insurance," Dr. Dickson said. "And we'll have to increase our capacity to be able to work with them to help them figure out what their options are."
UMass Memorial Health anticipates it will see 10 percent of its current Medicaid beneficiaries lose Medicaid coverage, and that about half of them will end up regaining coverage through an employer-sponsored plan or via Massachusetts Health Connector, the state's health insurance marketplace.
"We're bracing for a doubling of our uninsured rate from about 4 percent to 8 percent. And hopefully we'll get that down over the course of the year," Dr. Dickson said.
UMass Memorial Health includes UMass Memorial Medical Center, an academic medical center.
Dr. Dickson said he's particularly concerned about safety-net providers with high proportions of Medicaid patients.
"They have the smallest margins to start with. They have the smallest reserves to start with. And when COVID hit, they took care of a disproportionate share of COVID victims because it disproportionately hit marginalized populations living in poverty, and it's a poverty standard to get on to Medicaid," he said.
He added, "We better keep a close eye on how they're doing and be prepared to intervene if necessary, because we cannot have those critical hospitals for marginalized communities go under. They're so important for communities that are living with a high percentage of the population in poverty."