With continuous coverage ‘unwinding’, a big transition looms for Medicaid patients
Advocates warn that children could lose coverage needlessly if states aren’t careful
A two-month old gets a vaccination. (John Moore | Getty Images)
In less than two months, more than 1 million Wisconsin residents who rely on Medicaid will need to start signing up for the program again if they want to keep their health care coverage. Nearly half of those will be children.
After a three-year suspension because of the COVID-19 pandemic, it’s the first time in three years that participants in the state-federal health plan for low-income people and families will have to show whether they qualify.
“This has never happened before,” says William Parke-Sutherland, health care specialist at Kids Forward, a Wisconsin advocacy group for families and children. “There are very likely people who haven’t in years had to submit any information to maintain their eligibility. It’s a big change, and it’s a big lift for the state.”
By April, states must start issuing renewal notices to Medicaid participants, the federal Center for Medicare and Medicaid Services (CMS) has directed.
On Feb. 15 the Center for Children and Families (CCF) at the Georgetown University Health Policy Institute issued a report warning that more than 6 million children nationwide are at risk for losing health coverage if states aren’t careful in the months ahead while they manage the “unwinding” of the temporary federal requirement that states provide continuous coverage for Medicaid patients in the pandemic.
“Right now we’re at a critical crossroads and we cannot let children and families down,” said Dr. Lisa Costello, a West Virginia pediatrician who joined a Georgetown CCF press call to discuss the report’s findings. “When the Medicaid continuous coverage protection expires, we need to ensure children do not slip through the cracks and can maintain their health care coverage. Their health depends on it.”
Early in the COVID-19 pandemic, Congress temporarily suspended Medicaid’s requirement that people in the program renew annually and prove they are still eligible to be covered.
The legislation, included in one of the very first federal pandemic relief measures, required states to ensure continuous coverage for people on Medicaid, so they could get health care if they got sick in the pandemic. The measure also boosted the federal contribution to state Medicaid programs.
“Medicaid and the [federal] Children’s Health Insurance Program (CHIP) successfully brought down the child uninsured rate and proved to be a critical lifeline for more than half of the nation’s children during the pandemic,” the Georgetown University report states.
The continuous coverage provision was originally tied to the federal health emergency declared for the pandemic, but at the end of 2022, Congress voted to end the provision effective this coming April 1. The enhanced federal contribution will phase down through the rest of 2023.
According to the CCF report, in the two and a half years between when the continuous coverage requirement took effect in early 2020 and August 2022, the rolls for Medicaid and CHIP added 19.6 million people — nearly a 28% increase. In Wisconsin, they grew more than 32%, reaching almost 1.4 million — an increase of more than 340,000 patients.
Children accounted for more than a third of that increase — almost 125,000 — in Wisconsin, which ranked 11th among the 50 states and the District of Columbia in the growth of its Medicaid and CHIP population under 18. As of August, children in CHIP or on Medicaid, which includes BadgerCare Plus, were 47% of Wisconsin’s combined Medicaid and CHIP enrollment.
Until the continuous coverage requirement, Medicaid enrollment, including among children, would “churn off and on coverage due to bureaucratic barriers, confusing renewal notices or notices getting lost in the mail, technology hiccups, or slight income fluctuations,” the CCF report states.
“Children with parents who are hourly employees, work seasonal jobs, or work more than one part-time job are particularly susceptible to losing coverage as their family income is more likely to fluctuate and temporarily put them over the Medicaid or CHIP eligibility levels,” the report adds. “The continuous coverage protection nearly eliminated churn, protecting children from gaps in health coverage.”
Managing the transition
Advocates for the health of children, especially those in poverty, worry that the churn will start up again without the continuous coverage requirement.
For any number of “paperwork, bureaucratic processes that people can get caught up in, they could lose coverage and in the past have lost coverage, even though they’re still eligible,” Parke-Sutherland of Kids Forward says. “Wisconsin historically has had a fairly high churn rate.”
Some people lose coverage when they move and the renewal notice doesn’t get to their new address. Language barriers, or even difficulty in understanding “the complicated language” included in the renewal instruction, difficulty in submitting verification of their income, or other events can also interfere.
Parke-Sutherland says Wisconsin appears to be doing a good job of preparing for the unwinding. A tracker set up by CCF shows Wisconsin is among the leading states for posting necessary information to communicate about the process.
“I think our leaders need to do everything possible to protect Wisconsin children from getting caught up in red tape and losing their coverage,” he says. “BadgerCare is essential for Wisconsin kids, and if we don’t take the time and effort necessary, children will fall through the cracks and we will have children lose coverage unnecessarily.”
Elizabeth Goodsit, spokeswoman for the Department of Health Services (DHS), which administers Medicaid, is preparing to send letters to all people currently enrolled in the programs to tell them when they are due to renew. They will receive additional information on renewing by mail, and the letters DHS sends will also be posted on the DHS online accounts where participants can manage their benefits.
“We will not know how many people will need to transition to other forms of health care coverage until we receive their information” and determine whether they remain eligible, she adds.
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For recipients with a cell phone number or an email address on file, the department will send reminders by text or email 90 days before their renewal deadline, Goodsit says. DHS also plans social media campaigns about the renewal process, and it’s asking HMOs, other health care providers, health insurance navigators and community groups to contact Medicaid and BadgerCare Plus participants about the renewal requirement.
If a renewal applicant is no longer eligible, “they will be directed to other possible options to support their access to affordable health coverage,” Goodsit says.
DHS automatically sends the person’s account information to HealthCare.gov, the federal website for people to enroll in health insurance under the Affordable Care Act.
The department has updated messaging materials “to ensure that people who will need to transition to different coverage know how and when to access HealthCare.gov,” she adds. “We also tell them about the free assistance available from Covering Wisconsin, our state’s only federally funded, licensed, health insurance navigator program.”
Parke-Sutherland says Wisconsin has been reaching out to individuals and families enrolled in Medicaid, BadgerCare Plus and CHIP through social media, text messages, and other means, urging them to make sure their contact information is up to date and making information available in English, Spanish and Hmong.
“This is going to be a Herculean task to renew 1.4 million people over the next 12 months,” he says, “but I think Wisconsin is doing what we can to prepare.”
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