Thousands could lose health care when the federal public health emergency expires

State departments of health are bracing for the end of the COVID-19 federal Public Health Emergency (PHE), which will affect health care coverage for millions of Americans, especially those on Medicare or Medicaid — known in  Wisconsin as BadgerCare. 

The PHE was enacted in January 2020 by then-Secretary Alex Azar of the U.S. Department of Health and Human Services (HHS), implementing a wide range of policies such as requiring coverage of COVID-related health care expenses, expanding telehealth, and continuous coverage for BadgerCare recipients.

The continuous coverage meant that anyone who was on BadgerCare was no longer required to reapply every year to maintain coverage. The expiration date of the PHE hasn’t been set yet, but once it arrives, the state will have one year to have everyone on BadgerCare reapply and, for those who no longer qualify, help them find health coverage. 

“This is a big deal,” says William Parke-Sutherland, health policy analyst for Kids Forward. “We have to make sure to do our best for people because it’s going to be really easy for people to fall through the cracks.”

Kids Forward is a research and policy advocacy group focusing on children and families, particularly people of color and people living in poverty. 

According to the Wisconsin Department of Health statistics, in January 2020, 1.18 million Wisconsinites were registered for one of several Medicaid/BadgerCare programs; the latest numbers from May were 1.57 million, an increase of almost 400,000. 

“The one point to remember is there are a lot of children and parents and families and people with disabilities who are still eligible for insurance through BadgerCare Plus and other Medicaid programs, and it is very possible that many, many, many of them could lose coverage through this process,” Parke-Sutherland says. “There’s a risk that thousands of children and other people who are eligible — tens of thousands, potentially — could lose coverage.” 

People could lose coverage because DHS doesn’t have their contact information, they don’t know they need to reapply, or they reapply, find out they no longer qualify, and don’t know how to regain coverage. There’s also the risk that with such a large undertaking, people could just fall through the cracks. 

DHS has provided additional funding to help with the endeavor to Covering Wisconsin, a nonprofit licensed health care navigator with resources across the state to help with enrolling for health insurance on the federal exchange. During the renewal process, people who learn they no longer qualify for BadgerCare would be referred to Covering Wisconsin.

“Whenever there’s a transition point like this where people need to go through the renewal process, even just during normal times, that is just a challenging process to go through,” says Courtney Harris, ​​outreach and partner relations manager at Covering Wisconsin. “And so just making sure that people complete the renewal or their new application is a big lift in and of itself.”

Fortunately states may have several months to prepare for this transition. The PHE has been renewed every 90 days since it was first enacted and current HHS Sec. Xavier Becerra stated that the department would give state health departments 60 days’ notice before allowing it to expire. 

The Biden Administration announced it would extend the PHE in July for another 90 days, which would mean the next renewal deadline would be in October. It is unknown whether the PHE will be extended in October.

The Center on Budget and Policy Priorities released a report outlining what states can do over the next few months to minimize coverage loss, including public outreach outlining steps BadgerCare members can take in advance and finding ways to streamline the renewal process.

Even with the eviction moratorium, which expired in August last year, Parke-Sutherland pointed out that many people have been displaced over the course of the pandemic. Since they have not needed to renew since 2020, the contact information DHS has could be outdated for many members. Therefore, outreach is crucial.

“That’s going to require a real coordinated effort to make sure that we’re as careful as we can be,” Parke-Sutherland says. 

In an email, DHS spokesperson Elizabeth Goodsitt laid out several initiatives DHS is undertaking to improve communication in particular, including preparing messaging for members on the process, sending out materials encouraging members to update their contact information, and developing a system to text and email members with updates. 

The department is also working with partner organizations to raise awareness, particularly those in health care and food security, since the PHE also provided additional access for FoodShare recipients.

Other components of the transition could have implications that aren’t fully understood. The PHE took measures to make health care plans on exchanges more affordable, and required plans to cover COVID-19 preventative measures and care. Harris said it’s unknown what impact the expiration of those provisions will have.

Parke-Sutherland voiced concern that allowing COVID treatment provisions to expire could exacerbate the ongoing pandemic. He also pointed to a number of smaller provisions that improved access to telehealth under the PHE. Telehealth expanded health care access not just during the pandemic but for people that have challenges reaching a health clinic, including  the elderly, the disabled and people who lack access to transportation. 

Another potential wrench in the works was that the PHE barred any changes to BadgerCare, delaying implementation of a law that requires childless adults on BadgerCare to pay premiums and co-pays. The law was passed during the lame duck transition from the Walker administration to the Evers administration and was scheduled to be implemented in February 2020, but the PHE put that on hold.

“There’s tons of evidence throughout the country that increases to cost sharing, even modest increases like the $8 a month, which is what is proposed in the BadgerCare waiver, really impacts people’s access to care and will lead to disenrollment and people losing their coverage,” Parke-Sutherland says. 

To learn more about the “unwinding” of the PHE or spread awareness in your community, DHS has posted its communication materials on its website.