Protect Families’ Coverage When the Public Health Emergency Ends: A Health Advocate’s Survival Guide to Redeterminations

03.30.2023

Millions of people are at risk of losing their health coverage in the coming months. Why? Because the Public Health Emergency (PHE) declaration that has guaranteed Medicaid coverage during the worst of the Covid-19 pandemic is ending on April 1, 2023 – along with the pause on Medicaid redeterminations, the process of confirming that someone is still eligible for Medicaid.

The cumbersome process of redetermining a person’s Medicaid eligibility can unfairly result in eligible people losing Medicaid coverage or fail to connect ineligible people with another source of health coverage. If Covid-19 has taught us anything, it is the importance of ensuring that our families, friends and neighbors have access to health care when they need it. That is why it is so important for states to take immediate action to prevent millions of people from losing access to the lifesaving health care coverage they receive through Medicaid.

Because of the PHE, we’re currently experiencing the lowest uninsured rate ever and we don’t want to see it climb back up to pre-pandemic levels. Families USA is working with our state partners to protect people with Medicaid as states begin to seek to determine whether a person is still eligible for such coverage. To that end, we recently hosted a Medicaid Coalition and state partner webinar with speakers from Kaiser Family Foundation (KFF), the Nevada Department of Health and Human Services (DHHS), and DC’s Bread for the City. The speakers gave state and local advocates tools to help people who rely on Medicaid for their health care as they navigate the upcoming redeterminations process.

Below are guidances and resources to help ensure that, as states reintroduce the Medicaid redeterminations process, advocates are equipped to help keep families connected to the coverage they need and deserve to stay healthy.

Public Reporting

The Centers for Medicare and Medicaid Services (CMS) requires that states complete monthly enrollment reports. Advocates should be looking at the data on call center volume, wait times, and abandonment rates, as early indicators of problems with renewals. States have different priorities in terms of where their focus will be and how they will contextualize the data. Some states are committed to posting timely, useful data and others are eager to complete the redeterminations process as fast as possible. Groups monitoring the unwinding process will need to pull data from different sources, including CMS, state websites, and state/national organizations to get a full picture of how things are unfolding and to hold states accountable if people are losing coverage unnecessarily.

Outreach and Communication

Some states are committed to a transparent renewals process, which helps give real-time insight into how many people are losing health care access. Nevada DHHS, for example, is planning for Medicaid unwinding: including an operational unwinding plan, regular partner meetings, ex parte renewals (eligibility determinations made by the state without the enrollee submitting new paperwork), and an outreach and communications approach to inform enrollees. They also have an unwinding dashboard and collaborate with CMS and managed care organizations to share information and resources. Generally, advocates on the ground can help reach beneficiaries – in the ways that are most appropriate for the populations they serve – and help them navigate state processes for enrolling or continuing their health coverage.

Troubleshooting Problems and a Path Forward for Advocates

But even with localities committed to protecting coverage, issues can arise. For example, Washington D.C., has a locally funded program, the DC Healthcare Alliance, that provides health insurance for people with incomes at or below 210% of the Federal Poverty Level who do not qualify for Medicaid. The Alliance program was not subject to the protections of the PHE, so when it restarted its process of redetermining enrollee eligibility in August 2022, the process was plagued with problems including application system glitches and limited language assistance for a program that largely serves immigrants. The result was that people were losing their coverage without recourse. Bread for the City recounted a case where one woman lost her coverage, broke her arm, and the fear of large medical bills kept her from going to the hospital. Advocates jumped into high gear, and acknowledging the shortcomings, the Alliance suspended redeterminations.

Advocates took the pause brought on by the suspension to press the DC Council, the Department of Health Care Finance (DHCF) ombudsman, and they won the following concessions:

Extension of the recertification period from 6 to 12 months
Removal the in-person interview requirement
Creation an online enrollment option, District Direct
Data how shared with the DHCF ombudsman, who can resolve problems relating to coverage and access, assist people in finding health care resources, and help people understand their health care rights.

While D.C. advocates are still pushing to address staffing shortages, language barriers and a few other issues, the Alliance recently relaunched the redeterminations process – and because of the way it was improved, more D.C. residents are likely to remain insured.

The Washington, D.C. example provides a road map for Medicaid advocates. Advocates should expect to see challenges with eligibility staffing, technology platforms, and language accessibility. To confront these issues, advocates should be prepared to:

Push states to use the full 12 months for redeterminations
Urge states to eliminate unnecessary processes like in-person interviews
Work closely with other advocates, state partners, and state health departments to leverage all available resources
Post public data on state unwinding progress
Increase outreach and communications efforts to ensure enrollees are informed
Hire multi-lingual staff and provide multi-lingual notices to assist people with LEP/NEP
Make online systems more accessible and easier to navigate.

We don’t expect the next 12 months to be easy. But with the work of advocates, we are hopeful that we can enroll people in whatever coverage they are eligible for and protect the coverage gains made over the last three years.

Advocacy Resources