For months, chapters have been preparing for the end of the COVID-19 public health emergency (PHE) federal declaration, a milestone with tremendous implications for each state’s Medicaid population.
When the Families First Coronavirus Response Act was signed into law in March 2020, it provided states with a 6.2 percentage point increase in their federal Medicaid matching payments, conditioned on states maintaining coverage of all Medicaid/Children’s Health Insurance Program (CHIP) enrollees for the duration of the PHE. When the PHE ends, state Medicaid agencies will resume normal operations, which includes disenrolling families who no longer meet their states’ eligibility criteria.
However, before states actually disenroll families from Medicaid/CHIP, they will be required to conduct eligibility redeterminations for all enrollees across a 14-month period — a process the federal government has termed “unwinding.”
Medicaid experts caution this process could result in huge losses in coverage. A report from the Georgetown Center for Children and Families estimates that as many as 6.7 million children could lose coverage during the unwinding (https://bit.ly/3xUOcVI).
However, losses of this magnitude can be prevented.
“The message is ‘There’s time to get this right,’” said Pam K. Shaw, M.D., FAAP, chair of the AAP Committee on State Government Affairs. “Large coverage losses don’t have to be an inevitability. With the end date of the public health emergency still unknown, there’s plenty of time for preparations to ensure that individuals retain their coverage or are transferred to CHIP or a marketplace plan.”
At press time, the PHE declaration was scheduled to be renewed in July for another 90 days, running through Oct. 13. The federal government has committed to providing states with a 60-day notice before it ends the PHE, so states should know by Aug. 14 whether the PHE will end in October or be extended into 2023. This timing is important, as each state may begin its 14-month unwinding period up to two months before the end of the PHE but no later than one month after the PHE ends.
The AAP has developed tools to help chapters prepare for the unwinding. AAP State Advocacy has published an advocacy action guide (https://bit.ly/3QEwCxM) outlining what chapters need to know about the unwinding and strategies for local advocacy. The advocacy guide includes links to a template letter that chapters can send to their state Medicaid agency requesting a seat at the planning table and a checklist for chapters to review the unwinding operational plans state Medicaid agencies are required to develop.
Later this summer, the AAP and national partners will release materials to help clinicians communicate the redetermination process to patients.
Asked what steps physicians and chapters should take right now, Dr. Shaw offered the following advice: “AAP chapters can ensure state redetermination processes work for families and give them the best chances at retaining coverage. Pediatricians can make sure families who rely on Medicaid and CHIP update their contact info with the state Medicaid agency through their patient portal or customer service line. If families have moved over the last two years, it’s critical that they update their new address and contact information with their state Medicaid agency, so that when it’s time for their eligibility redetermination, they can be ready.”
For more information on state advocacy and resources on how to prepare for the unwinding, email the AAP state advocacy team at [email protected].
