An estimated 18 million people in the United States are on track to lose coverage of Medicaid when the public health emergency (PHE) issued in 2020 for the COVID-19 pandemic winds down.
That’s according to a recent analysis from the Robert Wood Johnson Foundation and the Urban Institute, which found that the end of the Covid-19 PHE will bring the largest health coverage changes since the implementation of the Affordable Care Act (ACA). Medicaid enrollment increased by more than 18 million from February 2020 to June 2022, thanks mostly to the Families First Coronavirus Response Act. Now, with the PHE likely to wind down soon, health coverage is about to undergo another major shift.
The analysis used the latest available administrative data on Medicaid enrollment, recent household survey data on health coverage and the Urban Institute’s Health Insurance Policy Simulation Model.
PHE background
The PHE has been in effect since the early days of the pandemic, and it has been reaffirmed every 90 days since. The Centers for Medicare and Medicaid Services (CMS) has indicated it will give healthcare stakeholders at least 60 days’ notice before winding down the PHE. And while that warning has yet to be delivered, CMS did tell healthcare providers to start preparing for it to end earlier this year.
As of now, the PHE will extend past January, after the Department of Health and Human Services (HHS) did not give that 60-day notice this fall. The PHE will likely be renewed again before its current ending date of January 11, 2023.
The PHE has played an important role throughout the pandemic, and it created many changes across the healthcare sector that will have impacts once it has ended. One of the biggest changes in the PHE is the extension of Medicaid eligibility, which gave millions health insurance coverage during the pandemic. Healthcare providers were also afforded more flexibilities and funding to deal with an influx of COVID-19 patients and reduce the spread of the virus, such as billing flexibilities for telehealth.
[VIDEO: MGMA explains why the COVID-19 public health emergency extension is critical]
PHE impact
While 18 million people currently covered by Medicaid will lose eligibility when the PHE ends, most will likely transition to other forms of health insurance coverage. However, an estimated 3.8 million people will become completely uninsured, the RWJF analysis found.
One concerning figure is that 19 states will see their uninsured rates jump more than 20% when the PHE ends, including: Arizona, Arkansas, Idaho, Indiana, Iowa, Kentucky, Louisiana, Maine, Michigan, Minnesota, Missouri, Montana, New Hampshire, North Dakota, Ohio, Oregon, Pennsylvania, Rhode Island and West Virginia. The current guidance from the Biden administration allows states up to 14 months following the end of the PHE to fully resume normal income eligibility redeterminations for Medicaid, though some states could choose to resort back to normal benchmarks even sooner.
Among children currently covered under the PHE, 3.2 million will transition from Medicaid to the separate Children’s Health Insurance Program (CHIOP) health plans.
The biggest danger of the PHE ending is the health coverage cliff, where people may find themselves without coverage. Education and awareness is critical to ensure a coverage transition.
“State Medicaid officials and policymakers must continue to ensure that individuals currently enrolled in Medicaid are aware of the approaching end of the public health emergency, and that they have a plan to maintain or find new health coverage through their employer, the federal healthcare Marketplace, or Medicaid,” the analysis stated.
Amy joined TriMed Media as a Senior Writer for HealthExec after covering home care for three years. When not writing about all things healthcare, she fulfills her lifelong dream of becoming a pirate by sailing in regattas and enjoying rum. Fun fact: she sailed 333 miles across Lake Michigan in the Chicago Yacht Club "Race to Mackinac."