End of Federal Public Health Emergency Causes Confusion for Beneficiaries and Providers

With the end of the federal public health emergency, some Medicaid recipients may no longer be eligible to continue coverage. During this emergency, some Medicaid programs, including traditional Medicaid, the Children’s Health Insurance Program, and the Healthy Indiana Plan, suspended traditional rules that required up-to-date paperwork and documentation to remain eligible for coverage.

Mark Fairchild is the director of policy and communication for Covering Kids and Family of Indiana.

In a previous interview, he explained that without the need for updated documentation, people with changes in their income or address have been able to stay in Medicaid programs when they traditionally could not.

“Since they aren’t doing those new checks, people who got into the program during the public health emergency were basically able to stay unless they did something like move out of state or had another dramatic change that would make them ineligible for an in-state program. from Indiana,” he said.

A federal spending bill Passed by lawmakers late last year decoupled Medicaid coverage protections from the federal public health emergency. Beginning March 31, 2023, traditional eligibility rules will resume when continuous coverage ends.

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As Medicaid recipients navigate different coverage options, some recipients and providers face confusion.

Fairchild said a big problem during this time is the different insurers involved in these Medicaid plans, which can make the information confusing for health care providers. Also, this confusion can lead consumers to assume that their health coverage won’t work in places where they may actually be eligible.

“If you can’t use your health care coverage, whether it’s Medicaid or a Healthy Indiana Plan or a private option, then you can’t get preventive care,” he said. “You can’t take good care of yourself, you can’t get help when you need it.”

He said Hoosiers may have trouble explaining their specific insurance company or the vision, dental and chiropractic subcontractors these companies may use.

For example, if a consumer has their Medicaid plan through Anthem, they can subcontract their vision benefit through an agency like Superior Vision. Certain providers can only take Anthem vision benefits when associated with this specific subcontractor. However, consumers may not know their subcontractors, and health care providers may not be informed about the insurance companies and subcontractors they work with.

Fairchild says this can add to consumer confusion.

“They may assume their coverage isn’t good anywhere, which means they’re left without that benefit,” he said. “And they go without learning what their health coverage can do for them.”

To mitigate these issues, Fairchild said one option may be to increase consumer education.

“Maybe it’s just sending out more fact sheets to providers, so they know how to talk to a consumer,” he said.

However, he said that consumers often already receive enough paperwork from supplier companies. Fairchild said other creative options may work better.

“The insurance companies themselves, the hospitals, an interesting element would even be to consider it in the schools,” he said.

In terms of maintaining coverage, Fairchild says that people who will soon lose their continued coverage should look into other coverage options and keep their information up to date.

“What everyone can do now is make sure their contact information is fully up to date with the state,” he said.

He said consumers should also look for mail from the Family and Social Services Administration or their insurance company to stay up to date.

Violet is our daily news reporter. Contact her at vcomberwilen@wfyi.org or follow her on Twitter at @comberwilen.

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