Payers, providers ask for 3-month notice of Medicaid redeterminations

Eight healthcare lobbying organizations want Congress to give their members at least three months notice before ending enhanced federal Medicaid funding and resuming eligibility redeterminations, they wrote in a letter to congressional leaders Thursday.

A decrease in federal support for states paired with a sudden increase in the number of uninsured people has implications across the healthcare system and time to prepare is necessary, the groups wrote.

“Sufficient notice is needed for states, health plans and providers to collaboratively engage with Medicaid enrollees to make them aware of the issue and to assist them in avoiding dangerous and unnecessary gaps in coverage and care,” says the letter signed by AHIP, Medicaid Health Plans of America, the National Association of Medicaid Directors, the Association for Community Affiliated Plans, the Children’s Hospital Association, the National Council for Mental Wellbeing and the American Health Care Association/National Center for Assisted Living.

Under the Families First Coronavirus Response Act President Donald Trump enacted in 2020, the federal government provides extra Medicaid funding to states during the COVID-19 pandemic. In exchange, states are required to maintain current eligibility and benefit standards and to pause eligibility reviews. Congress aimed to preserve health coverage during the pandemic and these policies will stay in place so long as a public health emergency declaration is in force. President Joe Biden’s most recent renewal of that declaration expires April 16.

Once states begin reevaluating enrollees’ eligibility, 15 million people who gained Medicaid coverage during the pandemic could lose benefits because their incomes changed since they enrolled, according to the Urban Institute.

Before the public health emergency is over, health insurers also want time to convert current Medicaid beneficiaries to other, more profitable products.

Centene, the largest Medicaid carrier with 15 million enrollees, is thinking ahead, the insurer indicated when it announced its fourth quarter earning last week. The company now participates in the health insurance exchanges in 25 of the 29 states where it has Medicaid contracts. Centene expects Medicaid redeterminations to begin in May.

“We’ve really built a platform between our exchange and Medicaid products,” Chief Operating Officer Brent Layton said during a conference call with investors. “From that standpoint, whether it’s network or communication or planning, we’re preparing for this.”

Anthem, the nation’s second-largest Medicaid insurer with 10.6 million members, expects its Medicaid population to decline 65% once states start verifying eligibility again. Anthem anticipates that 45% of those people will switch to employer-sponsored health plans and 20% will be eligible for subsidized exchange policies. Anthem doesn’t expect the public health emergency declaration to be renewed and predicts the redeterminations process will take a year to complete.

Like Centene, Anthem plans to transition customers who lose Medicaid coverage to other lines of business. “We are not expecting a cliff event associated with membership dropping off,” Chief Financial Officer John Gallina told investors while announcing Anthem’s fourth quarter results last month. “We expect to capture our fair share of those commercial members, and part of our commercial risk membership growth is predicated on the Medicaid reverifications.”