Stop insurance coverage losses when the public health emergency ends

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States can take steps to streamline enrollment and eligibility, facilitate coverage transitions, and invest in education and enrollment assistance to prevent coverage losses once the public health emergency (PHE ) COVID-19 expired.

Federal and state entities should monitor these policies to ensure successful enrollment and retention, and transitions for those no longer eligible for Medicaid to other quality affordable coverage, according to a report whose recommendations were adopted at the WADA 2022 Annual Meeting.

According to the AMA Council on Medical Service report, State Medicaid programs have seen two years of enrollment growth under the PHE. Armed with a temporary boost to federal matching funds, states had to guarantee continued coverage for enrollees in Medicaid and the Children’s Health Insurance Program (CHIP). This led to an increase of more than 20% in the number of people registered, which temporarily interrupted the “churn” of the program.

But once the PHE is completed, so does the continuing enrollment requirement. States will need to re-determine enrollees’ eligibility, ideally either by retaining them in Medicaid, if they remain eligible, or by helping transition those who are no longer eligible to other affordable coverage, such as through marketplaces. of the Affordable Care Act.

“The mass of impending eligibility redeterminations will be an operational challenge for states and could put significant numbers of Medicaid/CHIP enrollees at risk of losing coverage and becoming uninsured,” the report said.

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To reduce or avoid these scenarios, the AMA House of Delegates has adopted a policy encouraging states to facilitate transitions, including automatic transitions, from health insurance coverage to which an individual is no longer eligible to other health insurance coverage for which the individual is eligible.

According to the newly adopted policy, these automatic transitions must meet the following standards:

  • Individuals must provide consent to the applicable state or federal entities to share information with the entity authorized to determine coverage.
  • People should only be automatically transferred into health insurance coverage if they are eligible for coverage options that would cost them nothing after any subsidy is applied.
  • Individuals should have the ability to opt out of the health insurance coverage to which they are automatically transferred.
  • People should not be penalized if they are automatically transferred to coverage for which they are not eligible.
  • Those eligible for zero-premium market coverage should be randomly assigned to zero-premium plans with the highest actuarial values.
  • Targeted outreach and streamlined enrollment mechanisms to promote health insurance enrollment, which could include awareness of the availability of premium tax credits and cost-sharing discounts, as well as enrollment periods specials.
  • Automatic transitions should preserve, as much as possible, the existing medical home and patient-physician relationships.
  • Persons automatically transferred to a plan which does not include their doctors in the network should be able to benefit from the transitional continuity of care of these doctors, in accordance with Policy H-285.952.

Delegates also adopted a policy to support:

  • Coordination between state agencies overseeing Medicaid, Affordable Care Act markets, and workforce agencies that will help facilitate health insurance coverage transitions and maximize coverage.
  • Federal and state monitoring of Medicaid retention and opt-out, successful transitions to quality affordable coverage, and uninsured rates.

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“These policies are part of a long-standing AMA goal to expand access to and choice of quality, affordable health insurance coverage,” said Willie Underwood III, MD, MSc, MPH. , WADA Trustee. “We are concerned that once the public health emergency is over, new state eligibility determinations will result in more patients losing insurance. We hope states will employ strategies to help Medicaid-eligible patients retain coverage and transition those no longer eligible to other affordable health plans.

Check out other highlights from the 2022 AMA Annual Meeting.

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