Healthcare organizations ask Congress for continuous Medicaid eligibility

A coalition of 188 federal and state organizations has formally urged Congressional and committee leadership to provide 12-month continuous eligibility for Medicaid and CHIP beneficiaries. Their joint letter specifically requests passage of the Stabilize Medicaid and CHIP Coverage Act, H.R. 5434 and S. 3138. The legislation was referred to the Subcommittee on Health as of September 2023, per Congress.gov.

The signers of the letter represent a broad array of all stakeholders in healthcare consumers, payers, and providers, including the Alliance of Community Health Plans, American Academy of Family Physicians, America’s Essential Hospitals, and Trinity Health.

THE IMPORTANCE OF THIS EFFORT

This letter highlights that millions of enrollees lose Medicaid coverage within a calendar year, despite being often eligible, only to reenroll within mere months. Such disruption is attended variably by cumbersome paperwork, onerous reporting mandates, or temporary income fluctuation, according to the groups.

Currently, Medicaid provides coverage to adults for less than 12 months in a year. To be more precise, it covers nonelderly, nondisabled adults for approximately 8.6 months and elderly people along with the enrollments with disabilities for approximately 10 months.

Expressed another way, the Consolidated Appropriations Act of 2023 ensures that states provide 12 months of continuous eligibility pertaining to Medicaid and CHIP enrollees under 19 years and statutorily authorizes states to make 12 months of postpartum coverage available under Medicaid and CHIP permanently.

Because most people dropping Medicaid do not transition into other insurance products, including Affordable Care Act marketplace products or employer-sponsored insurance plans, but are uninsured. Income instability has ravaged many communities of color that have been disproportionately affected by the consequences of short periods of uninsurance before re-enrolling in Medicaid.

Continuous eligibility has been demonstrated as improving health outcomes, with providers benefiting from patients retaining their coverage.

A national 12-month continuous eligibility policy for Medicaid and CHIP would secure stable enrollment, allowing these programs to function more akin to private insurance and Medicare.

Also, it said in the letter, coverage gaps increase the average monthly cost of covering a Medicaid enrollee and result in increased, unnecessary administrative burdens for states, providers, and health plans. A recent study found that $1 billion in healthcare costs could be saved by households if 12-month continuous eligibility were instituted for adults.

Stability in Medicaid and CHIP coverage would reduce administrative burden on states, which currently make multiple eligibility determinations for enrollees, and on providers, who are overwhelmed by excessive requirements.

LARGER CONTEXT

Medicaid is a state-run program with joint federal and state funding. Medicaid continuously eligible was instituted during the pandemic’s public health emergency, when the federal government offered supplemental funding.

Just prior to the expiration of the public health emergency and federal funding this May, states began the process of Medicaid redetermination and about 16 million people lost their Medicaid coverage.

The letter highlights that the momentum for continuous eligibility is gaining even more ground. In contrast, five states offer 12-month continuous eligibility for all or some adults today, while more are considering such a policy to ensure eligible individuals stay covered.

Medicaid and CHIP provide health coverage for over 80 million Americans.

OFFICIAL STATEMENTS

“The alarming rate of disenrollment during the Medicaid unwinding only heightens the urgency of implementing robust state policies to maintain coverage. Communities of color are particularly vulnerable to falling through the gaps in coverage,” said Anthony Wright, incoming executive director of Families USA.

“Coverage gaps can quite literally mean the difference between life and death, as those caught in the churn face reduced access to treatments, delay necessary care, and more often end up in emergency departments.”

“We appreciate Congress’ work in legislating nationwide 12-month continuous eligibility for all children in Medicaid and CHIP through the Consolidated Appropriations Act of 2023,” said Jennifer McGuigan Babcock, senior vice president for Medicaid Policy at ACAP. “We now call for this protection to be extended to adults. No one should be afraid of losing access to comprehensive healthcare because of missing paperwork or fluctuations in income due to a few more work hours in a given month or an extra shift.”

Frequently asked questions

1: What is continuous Medicaid eligibility?
Continuous Medicaid eligibility is the fact that when somebody gets enrolled in Medicaid, he or she will remain for a specific period of time, usually 12 months, without the need for repeated eligibility checks.

2: What reason may continuous eligibility be so very important for Medicaid beneficiaries?
Continuous eligibility avoids gaps in coverage, allowing health care to be continuously available. This is very important in managing chronic conditions and preventing admission to emergency rooms.

3: Continuous Eligibility and Healthcare Cost
The continuous eligibility might be expected to raise costs; however, in the long term, there will be savings due to reduced administrative burdens and improved health outcomes, reducing the need for high-cost emergency care.

4: What major arguments exist against continuous eligibility?
Some opponents argue that this may result in increased spending on Medicaid or even the chance for people to game the system. They feel there is a need for periodic review of eligibility so that only the qualified receive benefits.

5: How can people support continual Medicaid eligibility?
However, individuals at the grassroots level can individually make a difference by contacting congressional representatives, actively participating in ongoing advocacy campaigns, and spreading the word on the importance of continuous Medicaid eligibility.

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