by Erik Gunn, Wisconsin Examiner
April 6, 2023
As changes to Medicaid intensify this month, it could push millions of people across the United States and hundreds of thousands in Wisconsin out of the low-income health insurance program, a Federal official said Wednesday that his agency’s top priority is to make sure people get through the process. without losing health care coverage.
In April, 30 states, including Wisconsin, will require Medicaid recipients to begin requalifying for the program each year for the first time in three years. Dan Tsai, whose job is to oversee Medicaid, said the federal government is working with states to help them manage the transition smoothly.
“But our job is also to make sure that our 92 million enrollees currently receive all of the procedural rights to which they are entitled, to maintain coverage,” said Tsai, director of the Federal Center for Medicaid and CHIP Services. (CHIP is the federal children’s health insurance program.) Tsai spoke to reporters during an online briefing Wednesday.
At the start of the COVID-19 pandemic in 2020, Congress passed legislation that increased Medicaid funds to states. In return, the legislation required state Medicaid programs to guarantee recipients continued coverage and waived the requirement for patients to register annually and prove they were qualified.
The continuous coverage requirement was to remain in effect for as long as the federal pandemic health emergency, declared in February 2020. Federal spending bill 2023 enacted in late 2022 ended the continuous coverage requirement effective 1 April, however, regardless of the health emergency. . (The federal government later declared the health emergency to end on May 11.)
According to the federal Centers for Medicare & Medicaid Services (CMS), 21 million people have been added to the nation’s Medicaid rolls since February 2020, an increase of 30%. In Wisconsin, Medicaid rolls have increased by 400,000, according to the Wisconsin Department of Health Services (DHS). DHS has not released an estimate of how many people the department says will no longer be eligible.
Nationally, Tsai said CMS projects 15.8 million people will leave Medicaid with the resumption of the renewal requirement.
About 8.6 million people are no longer expected to be eligible for Medicaid, mostly because their incomes exceed the maximum allowed by the program. About 2.8 million of them should be able to buy health coverage through the federal HealthCare.gov marketplace, with tax credit subsidies that make premiums affordable.
“Our goal is to help states (because they) help people smoothly transition to market coverage or employer-sponsored coverage, or Medicare for certain people – really to preserve coverage regardless where people get coverage,” Tsai said.
Administrative turnover
The remaining 7.2 million could lose their coverage “due to what we call the administrative church”, he added: they have not been deemed ineligible, but are removed from the rolls because they have moved and have not responded to the Medicaid renewal notice because they do not understand communications telling them to renew, or for some other similar reason.
To reduce this risk as much as possible, “We have spent the last year – more than a year – preparing extensively with our colleagues in the state, with our stakeholders, advocates, suppliers and others to want to preserve the cover,” Tsai said. “This is the most significant coverage event in the past 10 years in terms of the potential to impact (health) insurance (coverage) rates in the country and ensure equity in cover.
Eight states began requiring renewals in February, and 16 more began in March. Wisconsin is one of 30 states where the requirement went into effect in April. Renewals are for 12 months, and states contact Medicaid recipients to let them know their renewal date.
Depending on the state, the deadline for renewal is 60 to 90 days later. Five states — Arizona, Arkansas, Idaho, New Hampshire and South Dakota — could see Medicaid beneficiaries removed from the program starting this month. In 16 other states, beneficiaries who don’t renew or no longer qualify could lose coverage starting in May. Most other states, including Wisconsin, will begin seeing people terminated from Medicaid starting in June.
Tsai said the federal government is working with state Medicaid agencies on ways to overcome administrative hurdles that prevent eligible people from renewing. States are offered continued additional federal funding during the transition in exchange for bringing their enrollment practices into compliance with federal requirements.
For example, federal law since the passage of the Affordable Care Act (ACA) has required states to, where possible, automatically determine whether a person enrolled in Medicaid remains qualified.
“If you can match (an individual’s record) to data sources like the IRS or your state department of revenue, you can judge someone’s eligibility,” Tsai said. “They don’t even need to get a piece of paper in the mail. You want to maximize that under the federal framework for Medicaid determinations.
Facilitate renewal
Some states have been slow to comply with the requirement for automated enrollment re-determination. Getting more states to comply is “one of the most important priorities” during the current transition, Tsai said.
According to a March 2023 report from the Georgetown University Center for Children and Families and the Kaiser Family Foundation, Wisconsin processes less than 25% of its Medicaid renewals using the automated procedure without having to obtain information from the applicant. The same report found that 14 states process at least half of their renewals this way, and four states process 75% or more.
“There are probably things Wisconsin could do to improve that,” said William Parke-Sutherland, health care policy specialist at Kids Forward, a Wisconsin child and family advocacy and policy organization based in Wisconsin. Madison. “They could carefully consider who they are excluding from the administrative renewal process and whether there is a way to include them.”
Wisconsin also does not send renewal forms that are already partially filled out, with instructions for renewing Medicaid recipients to simply review the information, make corrections or additions as needed, which 32 other states already do, said Parke-Sutherland.
Tsai said that in states that have not accepted Medicaid expansion under the ACA — which allows a state to enroll anyone with incomes up to 138% of the federal guideline on poverty – ending continued Medicaid coverage will create a “coverage gap.”
This gap represents people whose income is below the federal poverty level and who are not eligible for Medicaid. They are also not eligible for the subsidies available to people who buy insurance in the health care market, because the subsidies are only available to people whose income is above the federal poverty level.
In Wisconsin, a federal waiver allowed single adults without children whose incomes meet the poverty line to obtain Medicaid, or BadgerCare, coverage that they would not be eligible for under standard Medicaid rules.
While that suggests there is no coverage gap here, Parke-Sutherland said there is.
People with incomes just above the poverty line are eligible for federal market subsidies, he said, but the copayments, deductibles and other out-of-pocket costs that come with insurance plans sold there make insurance unaffordable for them. For this reason, Kids Forward advocated for Wisconsin to accept Medicaid expansion under the ACA.
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