HJBR Nov/Dec 2022

46 NOV / DEC 2022 I  HEALTHCARE JOURNAL OF BATON ROUGE COLUMN MEDICAID An essential safety net Historically, Medicaid has played a vital role in helping states and regions respond to public health emergencies (PHEs). The Flint, Michigan, lead-contamination cri- sis, Hurricanes Katrina, Laura, and Ida, the California wildfires, and the opioid crisis are all examples of catastrophic events that have precipitated the need for a PHE declaration. And, by ensuring continuous enrollment for the pandemic’s most vul- nerable populations, the current COVID-19 PHE — declared January 2020 and reau- thorized every 90 days since — has allowed Medicaid enrollees to maintain stable coverage and receive the care they need during unprecedented circumstances and conditions. In other words, during a global health crisis when people need access to healthcare the most. Between February 2020 and April 2022, Medicaid/CHIP enrollment in America grew by almost 24%. Due to the pandemic, the country experienced a significant eco- nomic downturn, but Medicaid is designed for adverse economic conditions. A “coun- tercyclical”means-tested program, Medic- aid will experience an increase in enroll- ment and spending when employment and employer-sponsored insurance coverage decrease — an impact of the pandemic to the workforce here in Louisiana and writ large across the country by people who bore its worst effects. During average “cycles,”Medicaid expe- riences people rotating in and out of par- ticipation as their financial circumstances fluctuate. Losing a job can trigger eligibility while a pay raisemaymean ineligibility. But generally speaking, a significant portion of monthly Medicaid disenrollment numbers is procedural. Mail is unanswered or was never received, for example. However, on- going procedural barriers mean healthcare for many eligible families and individuals is disrupted. In addition to increasing care gaps and decreasing outcomes, temporary loss of coverage is costly to the state be- cause it requires additional administrative resources and oversight to re-enroll eligi- ble households. It may be that, by the time this column is published, the federal government has indicated it will not reauthorize the PHE in January 2023, and Louisiana will be pre- paring to initiate its planned “wind-down” efforts. What would that mean? Healthy Louisiana — the state’sMedicaid program— will soon return to pre-pandemic program requirements and have initiated redeter- mination efforts: facilitating renewals and reviewing eligibility for the roughly 40% of Louisiana residents who are enrolled in the program. However, many of those who ultimately lose Medicaid coverage af- ter the PHE ends will likely still be eligible for Medicaid or newly eligible for coverage through the marketplace exchange. Fundamentally, even a short-term loss of coverage will interrupt care, causing ad- ministrative burden for practices, denied claims, and adverse health outcomes for patients, especially for those who man- age chronic conditions, who are currently pregnant, or who have special healthcare needs. But Medicaid Managed Care Or- ganizations (MCOs) and their provider partners can help mitigate this scenario by urging necessary actionable steps and promoting helpful resources. Tell patients to make sure their contact information with Medicaid is current and correct Many enrollees may not have had con- tact with Medicaid in over two years. In addition, disruptions caused by the pan- demic may mean many have relocated. As a result, contact information may not be current, but it is necessary for helping enrollees maintain coverage: if they don’t receive their renewal paperwork, they can’t complete the steps needed to renew and will lose coverage even if they remain eligible. Contact information can be updat- ed using theMedicaid self-service portal at healthy.la.gov. Remind patients that if they receive a letter from Medicaid asking for information, they must respond or they will lose coverage To redetermine enrollee eligibility, Med- icaid must have their current income and household size. Those needing in-person help with renewal can find it at a Medicaid Application Center or Medicaid Office. THE END OF THE COVID-19 PHE Addressing Medicaid Redetermination When the Public Health Emergency Expires