CHICAGO – With potentially millions of people in danger of losing their health care coverage, the American Medical Association (AMA) endorsed several policies today at the Annual Meeting of its House of Delegates that aim to help them maintain coverage after the public health emergency expires.
“These policies are part of a longstanding AMA goal to expand access to and choice of affordable, quality health insurance coverage. We are concerned that once the public health emergency ends, state eligibility redeterminations will result in more patients becoming uninsured. We hope that states will employ strategies to help Medicaid-eligible patients keep their coverage and transition those no longer eligible into other affordable health plans,” said AMA Trustee Willie Underwood III, M.D, MSc, MPH.
During the COVID-19 public health emergency, states have been required to provide continuous coverage to Medicaid/Children’s Health Insurance Program (CHIP) patients as a condition for receiving a temporary increase in federal matching funds. Partially as a result, Medicaid/CHIP enrollment has increased by more than 20 percent. Once the public health emergency ends, states must begin redetermining eligibility for all Medicaid/CHIP enrollees, a massive undertaking that will be operationally challenging for states and may put some Medicaid/CHIP patients at risk of losing coverage and becoming uninsured. Because the mass redeterminations will significantly impact people of color, who make up more than half of Medicaid patients, it will be critical for policymakers to address health equity implications of the unwinding and how to prevent exacerbation of existing health care inequities.
States are preparing for the end of the public health emergency, and the policies AMA adopted aim to make sure that individuals who remain eligible for Medicaid/CHIP retain their coverage and those no longer eligible successfully transition to alternate coverage for which they are eligible, such as subsidized coverage through the Affordable Care Act (ACA) marketplace or employer-sponsored insurance.
To prevent coverage losses, the AMA recommends:
Streamlining enrollment/renewal: With traditional means of renewal, Medicaid enrollees face the prospect of losing coverage because they don’t mail back a renewal form or return information on time. To prevent this, some states automate renewals where possible by, for example, basing eligibility on available sources such as quarterly wage data, unemployment claims, or information from Temporary Assistance for Needy Families.
Investing in Outreach and Enrollment Assistance: Effective communications will be key to preparing for the mass eligibility redeterminations. States that effectively communicate with Medicaid patients can minimize coverage losses by making people aware of actions they must take to retain coverage or, if they are no longer deemed eligible for Medicaid, how to apply for no- or low-cost marketplace plans.
Adopting Continuous Eligibility: Continuous eligibility policies, which allow enrollees in Medicaid, CHIP and marketplace plans to maintain coverage for 12 months, have long been supported by the AMA as a strategy to reduce churn that occurs when people lose coverage and then re-enroll within a short period of time. Churn-induced coverage disruptions are most pronounced in Medicaid, both because income fluctuations are common and because Medicaid enrollees can lose coverage for procedural reasons. Once the public health emergency and continuous enrollment requirements expire, continuous eligibility will remain an option for states through Section 1115 waivers.
Encouraging Auto-Enrollment: The AMA supports states and/or the federal government pursuing auto-enrollment in health insurance coverage for those individuals eligible for coverage options that would be of no cost to them after the application of any subsidies. Candidates for auto-enrollment would, therefore, include individuals eligible for Medicaid/CHIP or zero-premium marketplace coverage.
Encouraging Automatic Transition: After the public health emergency expires, many people disenrolled from Medicaid because their incomes have risen will be eligible for subsidized marketplace coverage. In most states, however, transitioning people to marketplace coverage from Medicaid is not automatic and may be difficult for people to navigate. Additionally, some people disenrolled from Medicaid may not know that they are eligible for subsidized marketplace coverage or might think the plans are unaffordable.
Providing Monitoring and Oversight: It will be critical that states monitor the effectiveness of their policies and plans as the emergency unwinds. States might have to change direction if they become aware of concerning indicators, such as unusually high levels of churn or increases in the numbers of newly uninsured individuals. In particular, states should monitor Medicaid/CHIP retention and disenrollment data and uninsured rates.
“Throughout the public health emergency, Medicaid and CHIP have provided health coverage and care to more than 80 million people, including individuals affected by COVID-19 and those who experienced pandemic-related job losses. Because of federal support, the uninsured rate has remained steady even in the face of a pandemic,” said Dr. Underwood. “We must be vigilant that our patients don’t lose their coverage just because of a change in federal designation of a public health emergency. They are counting on us to find ways to stay covered.”