'A Looming Catastrophe': Experts Say Docs Must Prepare for Impending Medicaid Enrollee Drop

Aine Cryts

March 23, 2022

An estimated 15 million people with Medicaid coverage will lose their health insurance after the end of the Public Health Emergency related to COVID-19, according to research by the Urban Institute.

The Public Health Emergency was authorized by the Families First Coronavirus Response Act, enacted on March 18, 2020, in response to an estimated 23 million people who lost their jobs and employer-provided health insurance during the pandemic. It increased funding to states to support Medicaid while also preventing states from disenrolling members until the Public Health Emergency ends.

The dramatic drop in Medicaid enrollees is a challenge for provider organizations, since 71% of physicians accept Medicaid. To mitigate this drop in health insurance coverage, physicians must coordinate with state medical societies and Medicaid programs and tell patients to confirm their Medicaid eligibility, according to experts.

"This is really a looming catastrophe," Sabrina Corlette, JD, a research professor at Georgetown University's McCourt School of Public Policy and the lead author of a recent study, told Medscape Medical News. The study was funded by the Robert Wood Johnson Foundation and prepared by Urban Institute and Georgetown University researchers.

Corlette calls on physicians to pay attention to the end of the Public Health Emergency because it represents "the largest shift in insurance status since the Affordable Care Act went into effect in 2014."

Patients may not realize they have lost their Medicaid until they want to visit their doctor, said Corlette, who's also founder and co-director of Georgetown University's Center on Health Insurance Reforms.

Some patients who lose Medicaid coverage may be eligible for insurance through their employer or on a state-based insurance marketplace. "[But] private health insurance is very different from Medicaid. These patients don't realize they have a co-pay or co-insurance," she added.

The end result can be confusion and frustration between front-desk staff and patients when they arrive for appointments, said Corlette.

Continuity of care is another concern, because patients may be moved to different provider networks after switching from Medicaid to a new health plan. This is a particular problem for patients undergoing cancer treatment, she said.

Physicians Must Coordinate With Medical Societies, Inform Patients

According to the Centers for Medicare and Medicaid Services, more than 84 million people were enrolled in Medicaid or the Children's Health Insurance Program (CHIP) as of September (the most recent data available); this is an increase of 20%, or more than 14.1 million enrollees, since February 2020.

In February 2022, the federal government extended the Public Health Emergency, which includes a requirement that states continue coverage for people on Medicaid, to April 16. Although the Centers for Medicare & Medicaid Services gives states up to 14 months after the end of the Public Health Emergency to complete verification of patients' Medicaid eligibility, many states may be financially strapped without matching funds from the federal government, according to the study.

Corlette advises physicians to ask their state's medical association to coordinate directly with the state's Medicaid agency to streamline outreach to enrollees. In addition, staff at physician practices should communicate with patients by pushing alerts within patient portals and inform patients when they call the office or arrive for appointments about the need to respond to communications from the state Medicaid program to keep their coverage.

Ensuring equitable access to care is another area where physicians have a role to play, said Megan Cole, PhD, MPH, an assistant director and co-director of the Medicaid Policy Lab at Boston University School of Public Health.

"While states will have their own outreach strategies for supporting continuity of coverage, doctors and other providers may be best positioned to engage with the hardest-to-reach communities, including communities of color and those with unstable housing, if they're otherwise seeing those patients in their clinics or hospitals," she told Medscape Medical News. Cole wasn't involved in the study.

In addition, patients' chances of losing access to Medicaid occurs at the same time that federal funding is drying up for providers and hospitals that provide testing, vaccinations, and treatment for COVID-19 among people who are uninsured.

Paul Shafer, PhD, an assistant professor at Boston University School of Public Health, said "Many sick patients may stay home rather than seek care — risking their own lives and potentially delaying the end of the pandemic. More broadly, without health insurance coverage…people will also delay or forgo other medical care that they might need due to worries about cost."

Shafer, who serves as co-director of the Medicaid Policy Lab at Boston University, wasn't involved in the study.

He advises physicians to work with health insurance navigators at local community organizations who can help patients enroll in Medicaid, CHIP, or marketplace coverage, particularly in parts of the country where limited English proficiency is a significant concern.

"Understanding eligibility and navigating the processes to enroll and stay in these programs can be complicated. Having help to do it can make all the difference," said Shafer.

Aine Cryts is a veteran health IT and healthcare writer based out of Boston.

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