Since the COVID-19 pandemic began, Medicaid recipients in New Hampshire and nationally have benefited from a key safeguard: They cannot be kicked out of the program as long as the federal government continues its public health emergency.
That provision, passed by Congress in March 2020, has allowed Medicaid recipients to continue receiving that health coverage even if their salary changes or they age out of the program. Before COVID-19, Medicaid recipients had to renew every year.
But that public health emergency is expected to end soon, and as many as 69,174 Granite Staters risk losing Medicaid health coverage if they don’t take action, state officials warn.
President Joe Biden is expected to extend the public health emergency through at least April, and possibly later if renewed again. But Gov. Chris Sununu is pressing the Biden administration to end it then. On Monday, Sununu and 24 other Republican state governors urged the Biden administration to end the public health emergency in April, arguing that continued Medicaid coverage has “artificially” expanded the number of Medicaid recipients and has been too much. expensive for states to continue.
“We urge you to end the national emergency and the (public health emergency) in April and notify states of those intentions well in advance to allow us to adequately plan for the future.” the governors wrote.
It’s unclear when the Medicaid policy will finally end; The Biden administration has not announced how long it plans to keep extending the national emergency. But staff members of the Medicaid unit of the Department of Health and Human Services have been working since 2020 to reach out to Medicaid recipients to prepare them to prevent tens of thousands from potentially losing coverage.
New Hampshire has 100,481 people who are at risk of losing Medicaid as of December, 69,174 of whom have not renewed their eligibility, according to the state Department of Health and Human Services. Those people could be disenrolled in April if Biden refuses to renew the public health emergency program after that date, unless they take steps to renew their Medicaid eligibility or find other coverage.
The state estimates that 35,000 children are also at risk of losing care if their parents don’t take action, DHHS spokesman Jake Leon said Tuesday.
Not all of the 69,174 people who have not yet reapplied for Medicaid eligibility will be able to do so; that population likely includes people who are no longer eligible due to age or increased income level, officials say. It is unknown how many people that applies to in New Hampshire.
However, interested parties are rushing to contact all those affected. Those who are no longer eligible for Medicaid may be directed to buy subsidized plans in the individual market, either during the standard enrollment period, which ends January 15, or during a special enrollment period for which they qualify if they lose their Medicaid coverage. Those who are still eligible for Medicaid can simply reapply.
“We’re reaching out to as many families as we can,” said Lucy Hodder, a law professor at the University of New Hampshire and director of the Health Law and Policy program.
Significant enrollment increase
According to Sununu and the other Republican governors, the Biden administration needs to end the protection of Medicaid coverage because the measure has run its course and become too expensive.
Created as part of the Families First Coronavirus Response Act in March 2020, the continued coverage requirement came as part of a deal. The federal government would increase its traditional Medicaid reimbursements to states by 6.2 percent, a helpful help at a time when unemployment has soared and many people have lost health insurance. In return, states could not remove anyone from coverage for the duration of the emergency.
Like other states, New Hampshire’s Medicaid enrollment increased significantly. There are 69,980 more people in the Granite State with Medicaid in December 2022 than in March 2020, an increase of 39.4% in nearly three years.
Meanwhile, the federal state of emergency has been continually renewed in three-month increments, allowing people to continue receiving Medicaid even if they no longer qualify. The last renewal will expire on January 11. But the Biden administration has promised states at least 60 days’ notice before deciding to end pandemic status, and because the White House hasn’t given that notice, states assume it will be renewed. at least another 90 days, through April.
The Republican governors argued that the continuous coverage requirement “is costing states hundreds of millions of dollars.” In New Hampshire, the cost of that specific requirement is difficult to quantify. The increased numbers include people in both traditional Medicaid and Medicaid expansion, each receiving different reimbursement rates from the federal government. And it’s unclear how many Granite Staters are currently on Medicaid but would not be eligible if the continuous coverage requirement ended.
But the total cost of Medicaid in New Hampshire has increased. On Wednesday, the Executive Council will assume a $245 million increase to the state’s five-year contract with organizations that administer Medicare, $46.5 million of which comes from state funds and the rest from federal funds. That jump represents a 5.6 percent increase over the overall five-year contract.
In their letter, the governors argued that the end of widespread COVID-19 mitigation efforts is another justification for ending the federal public health emergency. “While enhanced federal matching provides some assistance in mitigating rising costs due to increased enrollment in our Medicaid programs, states must increase our non-federal match to adequately cover all enrollees and cannot disenroll program members unless they do so. voluntarily,” they wrote.
Hodder declined to comment on the governor’s letter, but praised Medicaid’s continued coverage policy in general, calling it “incredibly important to the people of New Hampshire.”
But he agreed that the Biden administration should give advance notice whenever it decides to end protections so states and advocates can prepare.
“It would be useful to know and have a long glide path to that date,” he said.
Ongoing efforts to reach families
Regardless of when coverage guarantees end, state employees and advocates are working hand in hand to keep people informed and insured.
At the Department of Health and Human Services, that work has continued since July 2020, Leon said. But it became urgent in recent months when the program seemed to be nearing the end.
The department has deployed an additional 30 staff members to reach Medicaid renewal recipients by phone, and those employees have made 41,000 calls since July 2020, 3,000 of which were follow-up conversations. It has employed a “pink letter” campaign to send eye-catching pink notices in the mail to people who need to renew. And it has partnered with other state agencies and organizations, according to León.
The result: 22,269 people have completed renovations so far, while 69,174 have not, León said Tuesday.
DHHS has worked with the Department of Insurance to connect people with insurance navigators to bring them to the individual marketplace if they no longer qualify for Medicaid. It has collaborated with the Department of Education on back-to-school messages to reach parents whose children could lose health coverage if they do not reapply for eligibility. And the managed care organizations themselves, which administer the Medicaid program, have been doing their own outreach.
Hodder and her colleague Deborah Fournier, a senior associate for health law and policy at the UNH Institute for Health Policy and Practice, have launched their own effort. The two lead a team that has taken advantage of social media, healthcare providers, insurance navigators and community members to try to get the word out about the need to re-enroll.
Those who need to renew coverage should go to nheasy.nh.gov, a portal managed by DHHS that provides assistance. They can also call 1-844-275-3447.
New Hampshire’s enrollment period for the individual market ends January 15. But if a person is no longer eligible for Medicaid in April and loses coverage, they can request a special enrollment period and joining an individual marketplace plan after the normal deadline, Hodder noted.
“We’re going to do everything we can … to make sure that no matter why you lose Medicaid or how you lose Medicaid, voluntarily or involuntarily, you have access to the market,” Hodder said.
This story was originally published by New Hampshire Bulletin.