Medicaid’s ongoing coverage, which was widely expanded during the COVID-19 pandemic, will shrink in the coming months.
This represents the largest shift in healthcare coverage since the Affordable Care Act was passed in March 2010.
The Centers for Medicare & Medicaid Services has temporarily waived certain requirements for individuals to maintain coverage during public health emergencies. The entitlement is now re-accessed.
About half a million people across Pennsylvania were able to get Medicaid because of the pandemic, said Michael Gusmano, a professor of health policy.
States will be able to terminate Medicaid enrollment for individuals who are no longer eligible as a result of the Consolidated Appropriations Act by April 1. For more information on important dates related to Medicaid Continuing Coverage, visit his website at: medicaid.gov.
One problem, however, is that administrative errors inevitably result in the exclusion of eligible individuals from coverage.
“Getting out of the pandemic, out of public health emergency rules, going back to the old ways of doing business with Medicaid, and allowing administrative complexities to push people out of necessary and eligible programs. is a move in the wrong direction,” Gusmano said.
Economics professor Chad Meyerhoefer said the process of unwinding Medicaid coverage was inevitable. The program originally monitored participant eligibility, but the pandemic has fluctuated in unprecedented ways, making tracking difficult.
Prior to coming to Lehigh, Meyerhoefer worked as a research economist at both CNA Corporation (a federally funded security nonprofit organization) and the U.S. Agency for Healthcare Research and Quality, and was familiar with the subject of Medicaid. His research focuses broadly on the economics of health and nutrition.
Not unexpectedly for Meyerhoefer, Medicaid’s unwinding highlights problems in the registration recertification process, he said.
Meyerhoefer said the recertification process varies greatly from state to state, and some individuals will be disproportionately affected by rollbacks.
In anticipation of these issues, the federal government has asked states to submit plans on how they will handle this process.
In states that did not expand Medicaid coverage, there are people whose income levels are too high to qualify for Medicaid, but who are too poor to qualify for subsidies under the Affordable Care Act. There will be, Meyerhoeffer said.
“People who are most disadvantaged may have the hardest time enrolling or maintaining eligibility because they find it difficult to comply with administrative requirements,” Meyerhoefer said. The problem is that we have a huge backlog of cases that need to be evaluated.”
He said volume increases the chance of administrative error.
according to Kaiser Family Foundation, “5 to 14 million people will lose their Medicaid coverage this year if the state “rolls back” its continuous enrollment provisions. ”
Meyerhoefer said individuals who had previously had Medicaid could be left behind simply because they are harder to find due to changes in addresses, phone numbers, and other contact information held by various organizations. said that there is
Gusmano said the process, known as “Medicaid termination,” is the process by which people temporarily leave the program and then return, causing disruptions to coverage and ability to access medical care and “devastating.” ” said it could lead to consequences.
“For a lot of people who are very vulnerable, this is a frightening development,” Gusmano said. “Across the state, thousands of people in the Lehi Valley area could lose insurance coverage when the public health emergency ends in the next few months.”
Meyerhoefer said strategies used to reduce the chances of truly qualified people being excluded from the program include hiring more administrative staff and finding new ways to communicate with the public. , facilitating the recertification of people based on age and disability status.
Meyerhoefer is confident that Bethlehem will not be overly affected. Instead, he predicts there will be more eligibility concerns in Allentown, as residents have lower than average incomes.
Lehi faculty continue to research the effectiveness of Medicaid and educate the public on the subject. Gusmano has researched that requesting business documentation limits access to programs and advocated universal his healthcare.
“We have a duty to share what we know so that policies are fact-based and we can have clear discussions about policy goals,” said Gusmano. “We should use this as an opportunity to force a debate about what is wrong with how people get access to health insurance.”
Meyerhoefer said having both the Lehigh Valley Health Network and St. Luke’s Health Network in the area would help mitigate the negative impact. Pennsylvania expanded Medicaid during the pandemic, allowing the state to focus on income-based eligibility and simplifying the process.
John Medalla and Kean Villanueva work as patient care partners within the Lehigh Valley Health Network. Both said they believe universal health care should be the norm, but that its effectiveness may be questioned.
“Effectiveness can fluctuate depending on the extent of medical care and what is provided, or how much treatment can be given,” Villanueva said.
Medalla agreed that the type of medical treatment determines its effectiveness regardless of the person’s location.
“Ultimately, I think it’s the gold standard that every country should have,” Medalla said.
Gusmano said he believes the U.S. should move away from the current health care model, in which people who are more ill are more expensive, and health insurance should not be tied to health conditions.
Meyerhoeffer agrees.
“If we can agree as a society that everyone should have access to healthcare, and if we can figure out how to make that happen, then we can definitely make this whole process easier,” Meyerhoefer said. “Instead of worrying too much about whether the country is moving towards nationalized health, let’s put our energy into creating an inclusive and effective system. ”
