The Complexity of Unwinding Medicaid

The long-heralded Medicaid “unwinding” has begun. As previously reported, state Medicaid programs have, since the start of the COVID-19 pandemic, operated under a law that prohibited them from disenrolling Medicaid enrollees for the duration of the public health emergency (PHE). Congress changed that requirement in December 2022, delinking the Medicaid continuous enrollment obligation from the PHE. Congress told states it was time to re-start Medicaid eligibility reviews (as early as Feb. 1, 2023) and terminations (as early as April 1, 2023, with completion due by April 2024). Please check your status today.


Since the start of the pandemic, US Medicaid enrollment has increased by more than 25%, to almost 91 million people. The resumption of Medicaid redeterminations will shock the system, threatening continuity of coverage for up to 18 million Americans (including nearly 7 million children). Some enrollees will lose Medicaid coverage because they are no longer eligible: they may now earn too much, or (in non-expansion states) they may have aged out of eligibility. Projections indicate, however, that almost half of coverage losses will occur among people who are still eligible. People who have moved since the start of the pandemic, people of color, non-English speakers, and people with disabilities are among those at especially high risk of coverage loss for administrative reasons. Alarminglya recent Urban Institute survey found that nearly 2/3 of responding Medicaid-enrolled adults had heard nothing about Medicaid renewals restarting.   


Gaps in coverage are extremely dangerous for people with bleeding disorders and other serious health needs. HFA and allied patient groups continue to urge lawmakers to design their “unwinding” plans around the goal of mitigating coverage losses and preventing such gaps. (Protective steps should include, e.g., communicating with enrollees in plain language and via a variety of channels, not just “snail mail;” allowing enrollees to renew their coverage online or via phone; spreading out redetermination caseloads over the full period allotted; and facilitating transitions to the Marketplace for those losing Medicaid coverage). 

At the grassroots level, HFA recognizes the important role that patient organizations can play in raising awareness. We are reminding community members with Medicaid coverage to make sure they’ve updated their contact information, and urging them to watch for and respond to communications from their state Medicaid programs. Working with NHF, HFA has compiled an easy-to-use outreach toolkit. We encourage member organizations, HTCs, and other partners to use that resource and join us in amplifying news about the resumption of Medicaid redeterminations. Watch, too, for an upcoming second phase of outreach that will outline options for people who may end up losing their Medicaid coverage as part of the “unwinding.”   

Quick Hits 

Source: Hemophilia Federation of America

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