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States are beginning to kick people off Medicaid, the program for the poor and people with disabilities, as a result of the end of the public health emergency resulting from Covid, with some already losing Medicaid coverage as of April 1.

Continuous Medicaid coverage without requirements for re-certification was authorized by federal legislation to insure that people maintained insurance. Because of current Covid trends, the emergency is scheduled to end May 11, 2023, according to the Department of Health and Human Services, and the end to the automatic Medicaid extension is one of the biggest changes expected.

Because Medicaid is a joint state-federal program, it’s up to the states to decide when they will either automatically cut people off, or determine that they may be disenrolled for any of several reasons — including the lack of a response to a form seeking to establish continued eligibility.

“The expiration of the continuous coverage requirement authorized by the Families First Coronavirus Response Act (FFCRA) presents the single largest health coverage transition event since the first open enrollment period of the Affordable Care Act. As a condition of receiving a temporary 6.2 percentage point Federal Medical Assistance Percentage (FMAP) increase under the FFCRA, states have been required to maintain enrollment of nearly all Medicaid enrollees. When the continuous coverage requirement expires, states will have up to 12 months to return to normal eligibility and enrollment operations,” Medicaid.gov wrote on its site, in an article titled “Unwinding and Returning to Regular Operations after Covid-19.” The page has a collection of resources.

A recent Kaiser Family Foundation news brief about Medicaid said: “Two-thirds of adults in the U.S. say they have had some connection to the Medicaid program, including health insurance (59%), pregnancy-related care, home health care, or nursing home care (31%), coverage for a child (31%), or to help pay for Medicare premiums (23%).”

Five states were set to begin disenrolling Saturday, April 1. They are conservative-led: Arizona, Arkansas, Idaho, New Hampshire and South Dakota.

Some states will take their time. All will do it differently, many using rolling deadlines, and all must be done within 14 months of the April 1 deadline.

Who is at risk of losing Medicaid?

The New York Times reported: “‘There’s 92 million people in our country that need to fill out paperwork all at once, in a very confined amount of time,’ said Dr. Jose Francisco Figueroa, an assistant professor of health policy and management at the Harvard T.H. Chan School of Public Health.”

Meanwhile, the people enrolled in Medicaid are largely unaware of this big change, according to a new study. About 64% of adults in a Medicaid-enrolled family in December said they did not know they may lose coverage once pandemic-era policy ends and eligibility checks resume on April 1, according to a survey from the Robert Wood Johnson Foundation,” Healthcare Dive wrote recently.

Some people will be kicked off Medicaid because they make too much money — a factor that was not considered uniformly during the auto-renewal period. Others may not know they need to re-certify; still others may not receive their notifications if their address changed.

Quite often, re-certification might include confirming income, or simply responding to a notification that re-certification is required. A form documenting size of household and other pertinent information is likely to be required.

Some people will be able to re-certify through healthcare.gov or their local state insurance-buying exchange, for example New York State of Health.

Automatic enrollment is ending in most states, starting April 1, but with a rolling deadline. Medicaid.gov posted a chart including dates for all states (see below): “the first month that members who have not had their eligibility successfully renewed in the past 12 months may be disenrolled for procedural reasons, such as non-response to a renewal form, per CMS guidelines,” the Medicaid site says, and also the date for terminations for individuals the state has redetermined as ineligible for Medicaid and CHIP may occur on or after April 1, 2023.”

In two states, New York and Minnesota, a Basic Health Plan set up under Affordable Care Act regulations will also require re-certification. New York’s is called the Essential Plan; Minnesota’s is the Basic Health Program. “With a BHP, the federal government pays the state 95% of what they would have paid in cost-sharing subsidies and premium subsidies if the BHP enrollees had instead enrolled in the second-lowest-cost Silver health insurance plan in the exchange. The state contributes additional funding as needed, and directs all the money to the managed care organizations that provide benefits under the BHP,” Louise Norris explained on healthinsurance.org. Those are the only two states that have a Basic Health Plan under the A.C.A.

The end of the emergency doesn’t change the situation in the non-expansion Medicaid states. Ten states chose not to accept the Affordable Care Act’s offer of more money to expand Medicaid. Those non-expansion states are Alaska, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin and Wyoming.

Other changes with the end of the emergency

The end of the emergency also means changes for several other programs. For instance, Covid testing: “Medicare beneficiaries who are enrolled in Part B will continue to have coverage without cost sharing for laboratory-conducted Covid-19 tests when ordered by a provider, but their current access to free over-the-counter (OTC) Covid–19 tests will end,” H.H.S. reported.

“The requirement for private insurance companies to cover Covid–19 tests without cost sharing, both for OTC and laboratory tests, will end. However, coverage may continue if plans choose to continue to include it. …

“State Medicaid programs must provide coverage without cost sharing for Covid–19 testing until the last day of the first calendar quarter that begins one year after the last day of the Covid–19 PHE. That means with the Covid–19 PHE ending on May 11, 2023, this mandatory coverage will end on September 30, 2024, after which coverage may vary by state.”

New York City Medicaid changes

In New York City, Medicaid enrollees might lose their coverage as soon as June 30, according to a briefing given by the New York Health + Hospitals staff on April 5.

More than 9 million people across the state are enrolled in Medicaid; CHP (sometimes known as CHIP), the children’s health insurance plan; and the Essential Plan. Many members have not been required to re-certify, so MetroPlusHealth, which serves 700,000 New Yorkers across the city is laying plans for a publicity campaign to make it easy for people to maintain enrollment or re-enroll if they lose their coverage. Between June and December 31, they said in the briefing, 339,000 people will be up for re-certification.

MetroPlusHealth will re-enroll or advise on coverage at the 11 New York Health + Hospitals public hospitals, and also at MetroPlusHealth offices at locations citywide. MetroPlus is also partnering with community-based organizations to make enrollment or re-enrollment easier. Renewal on their website is also easy.

Not everyone qualifies for Medicaid — for example, some immigrants are not eligible. As an alternative, the NYCCare program is a no- or low-cost health access program. It is not insurance, but it offers basic healthcare through the city’s public health chain.

“NYC Care is a health care access program that guarantees low-cost and no-cost services to New Yorkers who do not qualify for or cannot afford health insurance. All NYC Care services are provided through NYC Health + Hospitals,” the site says. “With NYC Care, you can get a unique membership card to access health services, choose your own doctor, and get affordable medications.” The program’s phone number is 646-NYC-CARE.

What you can do

Don’t get caught unaware. If you lose Medicaid, it can be hard to get back — depending very much on the state.

  • Above all else, for you or your kids or anyone else on Medicaid or the Child Health Plan (CHP): Be sure your address and phone etc. are up to date. A lot of people moved during the pandemic, and they may not realize that their Medicaid is not indefinite — and it could well depend on replying to a letter or phone call to insure renewal.
  • Are you on Medicaid? Check with your provider to see if you need to renew anything.
  • Are your kids on CHP (sometimes known as CHIP)? That is governed by many of the same rules. It depends very much state by state.
  • Same with the Essential Plan (in New York) or the Basic Health Plan in Minnesota.
  • Do you know anyone on Medicaid or CHP? Give them a heads-up.
  • In many families, the parents don’t qualify for Medicaid but the kids do qualify for CHP. Here’s our handbook on buying insurance.
  • Are you perhaps newly eligible for Medicaid because of a drop in income? Do your research and see if it makes sense to sign up. We ran a piece recently about how satisfied people are with their Medicaid experiences, which formerly had some amount of stigma attached.

Jeanne Pinder  is the founder and CEO of ClearHealthCosts. She worked at The New York Times for almost 25 years as a reporter, editor and human resources executive, then volunteered for a buyout and founded...