The official end of the COVID-19 public health emergency (PHE) remains unclear, but some states are already either planning for or taking actions regarding Medicaid enrollment. As you may recall, the Trump administration released guidance in December of 2020 to trigger preparation activities, creating room for states to be bad actors. Advocates have consistently raised the red flag that eligible beneficiaries would be kicked off of their Medicaid coverage amidst an ongoing pandemic if states retained the Trump era guidance flexibilities. The Biden administration took note.
In response to the concerns raised by advocates, CMS has issued updated and much-welcomed guidance. This new guidance, in the form of a State Health Official letter, seeks to ease some of the overwhelming workloads that state Medicaid agencies are already experiencing in light of record enrollment figures as well as prolong the timelines to more adequately process redeterminations, resume normal operations, and most importantly, reduce the likelihood that eligible beneficiaries will unnecessarily be kicked off of Medicaid.
What does the updated guidance do?
Slows the process: Extends the timeframe for states to complete pending eligibility and enrollment actions by up to 12 months after the month in which the PHE ends.
The original guidance from December 2020 provided a very limited timeframe of six months after the month in which the PHE ends to complete pending post-enrollment verifications, redeterminations based on changes in circumstances, and renewals. Because states cannot process these items during the PHE, there will undoubtedly be a backlog once the PHE ends. Simply put, the longer the PHE stretches out, the more likely that state Medicaid enrollment grows. With only six months to process the information, states would be more likely to take shortcuts such as inadequate outreach to beneficiaries and insufficient time for beneficiaries to respond to requests for information.
Under the new guidance, states may take up to 12 months after the month in which the PHE ends to complete pending verifications, redeterminations based on changes in circumstances, and renewals. This will allow states to stagger the workload to avoid overwhelming call centers and reduce some of the administrative workloads, both of which contribute to burdensome application processes for beneficiaries trying to figure out their coverage status.
It is important to note that the revised CMS guidance did not change the timeframe of four months in which states must resume the timely processing of all applications to ensure timely access to coverage for eligible individuals. In other words, the welcome mat is still out even as state Medicaid agencies are tasked with helping individuals transition to other health insurance opportunities in the event that they are no longer Medicaid-eligible.
Safeguards people’s coverage: Requires an additional redetermination for individuals determined ineligible for Medicaid during the PHE.
The original guidance from December 2020 gave states the option to compile disenrollment lists in the final six months of the PHE. Several of our state partners vocalized concerns that this particular section from the original guidance could lead to their states developing massive disenrollment lists based on inaccurate or outdated information and/or encourage their states to take shortcuts in processing redeterminations during the final six months of the PHE leading to more people being disenrolled. CMS also acknowledged in their guidance that this aspect of the original guidance would carry “inherent risk that coverage will be terminated for some eligible beneficiaries.”
Under the new guidance, with states now able to have 12 months to complete pending eligibility and enrollment actions, CMS will not allow states to terminate coverage until the state has completed an individual’s redetermination after the PHE ends. Thanks to the continuous coverage requirement afforded by section 6008 of the Families First Coronavirus Response Act (FFCRA) (Pub. L. 116-127) as amended by the Coronavirus Aid, Relief, and Economic Security (CARES) Act (Pub. L. 116-136), many people remain covered through Medicaid despite various circumstances throughout the course of the pandemic. For example, many have experienced housing insecurity during the pandemic and have not submitted updated information/change of address or have otherwise not responded to Medicaid agencies’ requests for information. Under the new guidance, these individuals will now have another opportunity to submit the needed information to retain their coverage. It is important that states take all of the possible steps to ensure the continuation of coverage for eligible individuals.
We believe CMS’s updated guidance will address many of the concerns our state partners were already beginning to raise and we thank CMS for considering how the original guidance from December 2020 would affect Medicaid beneficiaries and Medicaid agencies alike. We encourage our partners to continue to monitor their state to ensure that their processes align with what CMS has laid out in this guidance.