15 Million at Risk of Losing Medicaid

(film reel clattering) - Welcome to today's Ethnic Media Services Zoom news conference, our regular Friday national news briefing.

I'm Sandy Close, director of EMS, and we're grateful to the Center for Budget and Policy Priorities for co-hosting today's briefing, helping us plan, and connect to some very important experts.

And, thank you to the Center for co-hosting.

Today's briefing focuses- and it's a very dramatic term- on "The Great Unwinding."

15 million people at risk of losing Medicaid or Medi-Cal as it's known in California.

On April 1st, states will resume reviewing all 86.7 million Medicaid enrollees' eligibility, for the first time since the pandemic began.

And, they will begin ending coverage for those deemed ineligible.

This process is called, "unwinding", and according to estimates, it could result in up to 15 million people leaving the program.

Eligible individuals and families, particularly people of color and children, many, many immigrants, are at risk of losing coverage during the unwinding process despite remaining eligible for Medicaid or becoming eligible for other types of low-cost coverage due to administrative hurdles they must overcome to maintain their coverage.

EMS partnered with the Center for Budget and Policy Priorities to bring this topic to the attention of our audiences and to explain how to avoid losing badly needed coverage.

An expert from the Children's Partnership, also a longtime partner based in California, will also speak.

The speakers include Farah Erzouki, senior policy analyst with the Center; Laura Guerra-Cardus, director of State Medicaid Strategy; Kristen Testa, director, California Health Programs, Children's Partnership, based in Los Angeles.

Now, I turn the microphone over to Pilar Marrero, editor at EMS, who will moderate today's briefing.

Pilar, please go ahead.

- Thank you, Sandy.

Hi!

Good morning, everyone.

Thank you for joining us for this very, very important briefing on a topic that's going to affect a lot of people in our communities.

I'm gonna invite Farah Erzouki, senior policy analyst for the Center of Budget and Policy Priorities to give us a first view or a first look of what this unwinding can look like.

Farah, thank you for joining us.

- Thank you so much.

The issue we're talking about here today, as Sandy mentioned is what's been termed "The Medicaid Unwinding".

Since March of 2020 through COVID legislation, states have mostly kept people covered through Medicaid without interruption in exchange for an increase in their Medicaid federal matching funds.

This policy known as the continuous coverage requirement allowed millions of people to keep their Medicaid during the public health crisis and not be subjected to paperwork requirements or other administrative barriers that usually result in people turning on and off the program.

Access to coverage and healthcare services has been critical during this time of increased hardship.

At the same time, this continuous coverage policy has meant that most Medicaid enrollees probably have not had contact with their Medicaid agencies in three years, and in some cases even longer.

People have moved during the course of the pandemic meaning their addresses and contact information have potentially changed.

This poses a risk during the unwinding process that people may not receive their renewal notice or some important information in the mail.

And if they do, they may not understand it or might struggle to submit the information on time.

These challenges will be made even more difficult with the staffing crisis that Medicaid agencies are facing all while preparing to manage the historically high caseloads ahead of them.

Medicaid agencies could fall behind in processing cases and documents and all of these challenges combined could result in large coverage losses.

Experts estimate that 18 million people will lose their Medicaid coverage during the unwinding process with seven million of them still being eligible, but losing coverage for procedural reasons such as the ones I touched on, such as not receiving or submitting paperwork on time, not being able to get a hold of their Medicaid offices, among many others.

And, that risk is particularly high for children and people of color.

We know that procedural barriers or the red tape that people experience in trying to access Medicaid have deep roots in systemic racism.

People of color are disproportionately impacted by these procedural barriers and this makes it more difficult for them to enroll and stay enrolled in safety net programs like Medicaid despite being eligible.

Research predicts that while 17% of white enrollees will lose coverage during the unwinding for procedural reasons, Latino, Asian, native Hawaiian Pacific Islander and Black enrollees are much more likely to lose coverage for those reasons: 64%, 50%, and almost 40% respectively.

Additionally, almost three-in-four children are predicted to lose coverage despite being eligible.

These stark numbers underscore the inequities that communities of color and children experience and the need for an all-hands-on-deck effort to support these impacted populations through the unwinding process.

The year-end congressional spending bill that was passed in December set a date certain for the end of this pandemic policy.

It ends on March 31st of this year, which is in just over 60 days.

This means that enrollees could begin losing their coverage as early as April 1st.

Every state will have its own approach and timeline for processing their historically high caseloads and starting their case renewals.

And, it takes states anywhere from 60 to 90 days to complete a full renewal.

Some states will initiate renewals as soon as February meaning that some enrollees will start receiving notices in the mail about their coverage as soon as next month but other states won't begin initiating their renewal process until April.

So, we will see drops in coverage in those states starting to happen closer to over the summer.

Most states will take 12 months to process their full caseloads.

So, this will be a long process that will happen through the rest of 2023 and well into 2024.

[mouse clicking] Even though the stakes are high and the timeline is inching closer by the day, the good news is that coverage loss is not inevitable.

State agencies can and must act now to ensure that eligible communities have the information they need to stay covered, and that people who are not eligible for Medicaid anymore can transition to another form of coverage.

States can also use this opportunity to make improvements to their own processes to reduce red tape and make it easier for people to renew their coverage, and such improvements will have long-term benefits.

One of the most important things for state agencies to do is to make sure they are communicating effectively with Medicaid enrollees.

To do this, agencies should work to make sure they have updated enrollee contact information so that when notices start to come in the mail people receive them and know it's time to take action.

They should also use different methods to contact people like text message and email, especially given it may be more difficult than usual to reach them by mail.

Partnering with community-based groups and trusted partners is also critical to communicate messages to people on the ground, including communities of color and immigrant populations about the need to renew coverage or to help them to transition to other types of coverage through the marketplace which my colleague Laura will touch on more.

We know that Medicaid agencies are facing a staffing crisis and there are strategies that states can employ that would simplify the renewal process and reduce the strain on workforces.

State agencies should automate more renewals using electronic data so they don't have to contact every single enrollee directly to renew their coverage.

This would reduce procedural errors and would also ease the strain on case workers.

They should also make sure that people can renew their coverage online or over the phone.

This is a federal requirement but some states have yet to implement it.

And, they should find ways to address their staffing shortages by hiring more workers, allowing overtime, or bringing back retirees.

These fixes are worth investing energy into, even if they aren't ready right when the unwinding process begins.

The stakes are high with the coverage of millions of people on the line and proven solutions at their disposal.

State agencies must act to make this process smooth and effective to protect enrollees and minimize coverage losses throughout the unwinding process.

And, with that, I'll turn it over to my colleague Laura who will talk more about the messages that communities need to hear now to prepare for the unwinding.

- Thank you, Farah.

Hello, everybody!

As we just heard from my colleague Farah there is a lot that states can do and need to do to prepare for the unwinding so that eligible people do not lose coverage, and states across the country will do a variety of quality of job.

Their work in this area will vary state to state.

So, it is critical that in addition to urging state leaders and state agencies to do all they can that we also do all we can to make sure that communities of color have the information they need to protect their coverage and their family's coverage.

Ethnic media outlets can serve as a central partner in helping protect people's coverage and the care and financial protections that come with it.

So, the key messages that we collectively need to get to families are summarized in this slide.

People need to update their contact information, let those on Medicaid know that they will once again need to complete the eligibility renewal process for Medicaid or risk losing coverage, and that they need to make sure that their Medicaid agency has updated contact information for them.

Check your mail.

Let people know that they need to make sure to check their mail, and keep an eye out for letters from either Medicaid or CHIP.

Let them know that they could receive their renewal notices at some point this year or early next year.

Because, remember, states will have about a year to initiate the renewals.

And so, people could be on the earlier side of the renewal process or on the later side.

So, they should be alert to this the rest of this year and early next year.

Let them know to complete the renewal forms if they get one.

For those that no longer qualify for Medicaid, let them know that they may be able to get affordable coverage through the Affordable Care Act marketplace, and to learn more by visiting healthcare.gov As Medicaid enrollees go through these redeterminations in expansion states, the majority of those going through the redetermination will have an affordable coverage option available to them no matter their new income or circumstance.

However, in the 11 non-expansion states that remain, hundreds of thousands of people stand to lose their Medicaid coverage with no other affordable coverage option available to them.

Those most likely to fall into what we call the "Medicaid coverage gap" where they don't qualify for their state's Medicaid program but do not earn enough money to get financial assistance on the marketplace are the following groups: young adults who turn 19 during the pandemic and will no longer qualify for children's coverage; parents with extremely low incomes who either have no longer have a dependent child or their income has rid risen above the very low threshold that the states have; and, the third is postpartum people that are past their state's eligibility period, which could be anywhere from 60 days to 12 months after the end of pregnancy in the non-expansion states.

For these groups to avoid falling in the Medicaid coverage gap, often their income needs to rise significantly.

For example, a Texas mom would have to see her income rise six times from $3,700 to $23,000 to afford-- to be able to get an affordable coverage option in the marketplace.

[mouse clicking] Many of those people in the non-expansion states which is why it's a new call-to-action to those states to ensure that people have access to healthcare coverage no matter their income circumstances, where they live or who they are.

- Okay, thank you very much.

Anything else?

Oh, Kristen!

I have a question for you, but go ahead!

(chuckles) - I just wanted to piggyback on that.

You know, we saw continuous coverage as a health equity policy because it is a core piece of what coverage can be.

It is what can equate it to how our employer coverage works.

For all of us to have the privilege of employer coverage, we don't have to go through that level of paperwork every year to renew our coverage.

It either is continued or we change a plan but we don't have to requalify every year.

And, here's an opportunity to equate a very large and important health insurance program with the other large insurance program that's offered at-- through employers.

So, this is a way to really get at continu-- (stammers) universal coverage is by having continuous coverage be permanent in Medicaid, as we are trying to do starting with young children in California.

- So, Kristen, help us understand this.

CHIP was supposed to guarantee all kids had access to healthcare.

How does this affect that guarantee?

[mouse clicking] - Well, yes.

In California, all children are eligible for some form of coverage, and because we also cover children regardless of immigration status.

And-- but where they lose coverage is in this back-and-forth falling off coverage because they didn't get the renewal packet.

So, that's where most of our lack of coverage is occurring is in the lack of continuous coverage.

By example, what we've seen during this continuous coverage period, this temporary continuous coverage period, is that the churning rate, the back-and-forth rate, has decreased by a fourth; into a fourth of what it used to be before the pandemic.

That's an enormous drop.

It's now less than 1% where it was closer to 9% or 11%.

So, that's an enormous drop in those that are falling off of coverage when they needed to have it and then having to re-enroll.

[mouse clicking] - Thank you so much.

- I know that when I was looking for coverage that-- you know, you put your name into a website, and then you've got a hundred people calling you offering to enroll you.

How do we determine which of these are scams, and which of these are authentic providers that will enroll you in ACA programs?

(silent hesitation) - [Pilar] Anyone?

- [Farah] In a bit!

I'm looking up as I'm unmuting!

I can put a resource in the chat.

I believe it's Young Invincibles manages a site to help people locate help with enrolling for coverage.

And they weed out, of course, scams, but even, I guess, for-profit entities: the brokers and groups like that.

So, they only have kind of nonprofits and organizations that are receiving federal funding to help assist people enroll in the marketplace.

So, I'll put that link there.

And then, I might have another good one as well.

- Are there culturally and linguistically appropriate resources that you can point to?

Because so many of, you know, people of color as you mentioned, are-- stand to lose coverage.

- In addition to the resource that Laura mentioned, I know that healthcare.gov also has a similar search function.

So, it's called Find Local Health.

And, when you search for someone through, you know, that's close to you through that, through that tool, you can see what languages they speak.

So, it has that information available on that website.

[mouse clicking] - [Pilar] Thank you.

Thank you so much.

So, it's very important that we know what resources to tap in order to cover this issue from wherever we are but we also wanna know what this means at the macro level.

So-?

We were supposed to be moving forward on healthcare and I think we are, but this sounds like a step back on the issue.

Does this mean we are going backwards on healthcare access?

Do you guys have an opinion on this?

Or, is this just a bl-- a blip that-- not a blip, obviously.

It's a lot of people but is this just a-?

You know?

Obstruction on the way, and we are on the way to better healthcare in the future?

Better access, or-?

(silent hesitation) Anyone wanna opine on that?

- I can say a few words.

I think we as a country should feel very proud of being able to keep so many people connected to healthcare coverage during a global pandemic.

And, at a time when there was also a concurrent kind of economic crisis with people losing access to their employer-sponsored coverage where we would've expected health-- more people to become uninsured.

And, instead what we saw is more people gaining coverage.

So, it serves as a model going forward as to what is possible in this country.

And, as far as said, the continuous coverage protection was created as a temporary-- as a temporary policy during the pandemic.

And now, we must do the work of reconnecting with people to see what their new situation is, and connecting them to the appropriate healthcare coverage.

We certainly do not yet have universal coverage, but for those that are currently in Medicaid, there should be an affordable health coverage option available to all of them except, or the large majority of them, except many of those people in the non-expansion states which is why it's a new call-to-action to those states to ensure that people have access to healthcare coverage no matter their income circumstances, where they live or who they are.

- Okay, thank you very much.

Thank you to all three of you.

Thank you to CBPP and the Children's Partnership for your help, and for always being there when we need to explain these complicated things.

We really appreciate it.

Sandy, you wanna say some words at the end and we can end early?

For a change?

(chuckles) - No, no.

And, thank you to all our reporters who've joined this very informative news you can use!

Lord!

I am-- I have to say I haven't seen a lot of coverage on this.

And, I got a call from a mainstream TV reporter in the Bay Area asking for more information.

I don't think this is really on people's radar.

So, this has been a very important kind of alert to all of us.

[background music] The Children's Partnership did a briefing for us on this a year ago, but things get buried!

And, we have huge new crises like the atmospheric rivers in California.

And now, just the two mass shootings.

You just lose sight of these longer term trends that are going to have such significant impact.

So, thank you all for making this a very helpful briefing on, I think, [background music] a topic that as the sooner we report on it the better.

And, clearly, we have to keep monitoring it.

Thank you so much.

- Absolutely.

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