States expect up to a year to finish Medicaid redeterminations after COVID-19 emergency ends

By Robert King / September 16, 2022

Several state insurance regulators believe it could take up to one year to fully finish redetermining eligibility for their Medicaid populations after the COVID-19 public health emergency (PHE) ends.

State regulatory officials and a consumer outreach group shared how they are preparing for the end of the PHE during a meeting Thursday of the Medicaid and CHIP Payment and Access Commission, which advises Congress on Medicaid and CHIP issues. While preparations are underway, some said that more funding and outreach could be needed.

In Florida, advocates such as Jodi Rey of the nonprofit Florida Covering Kids & Families are still awaiting word on the state's plan to handle the unwinding. 

“I would say from a stakeholder perspective it’s disappointing for Florida,” she said. “We have a state that currently hasn’t shared our plan so we’re not entirely sure what the state is planning on doing and what information they are going to be willing to share.”

The nonprofit, which is a part of the University of South Florida, is also concerned about transitioning people off Medicaid into other coverage sources such as the Affordable Care Act’s exchanges. 

“Currently we have over 5 million people on Medicaid, so this is absolutely concerning,” said Rey, the center’s executive director. “We’re really concerned with the seamlessness of being able to move enrollees from CHIP and Medicaid into the Marketplace. It is currently not a seamless process in Florida."

Rey said the center has asked the state to update how those transfers take place. 

States and advocates are reviewing their processes for outreach and enrollment renewal to prepare for when the PHE eventually goes away, which is likely to take place sometime in the next year. 

At the onset of the pandemic, the federal government agreed to increase the matching rate for Medicaid payments to states if they did not drop anyone off Medicaid or CHIP for the duration of the PHE. 

Currently, the PHE is expected to be extended in October for another 90 days, but the Biden administration may not keep it going well into 2023. 

States and advocacy groups have been ramping up their process for redetermining which of their Medicaid residents should remain on the program or transition to other coverage. 

In Arizona, for instance, state regulators have been partnering with its managed care health plans to help reach out to beneficiaries who may lose coverage, said Jami Snyder, director of the Arizona Health Cost Containment System, the state’s Medicaid agency. 

“We also at the agency level have conducted a robocall campaign to find those individuals, a text message campaign and a letter campaign,” she said. “We are really trying to cover all the bases in terms of reaching out to those individuals.”

The goal is the plan or the provider will then also have conversations with the individuals to update their contact information and can update their eligibility information, she added.

Snyder estimated that it will take a year to fully redetermine eligibility for everyone on Medicaid in the state. 

The Centers for Medicare & Medicaid Services has given states 14 months after the PHE ends to finish all redeterminations. 

However, the exact time frame for each state to finish the redeterminations could vary depending on several factors, chief among them funding. 

Pennsylvania is also projecting that its redeterminations could take between six months to a year, but it may be only six months if the federal government doesn’t provide more funding, said Carl Feldman, an executive policy specialist in the state’s Medicaid agency. 

Currently, the federal government is providing matching funds until the end of the quarter in which the PHE ends. 

As of July 13, the state has identified 314,000 cases that haven’t completed the renewal process since the start of the PHE, Feldman said.