On the 17th of January, Republican Congressman Brett Guthrie introduced the Pandemic is Over Act, a bill that would abruptly end the COVID-19 public health emergency on the day of enactment. If the Guthrie bill became law it would cause chaos in the health care system, sabotage the bipartisan Medicaid and health care provisions in the December Omnibus package, and likely result in millions being thrown off the Medicaid rolls.
The Biden administration and Democrats in Congress have, through passage of the American Rescue Plan and the Inflation Reduction Act, provided continuous Medicaid coverage to working Americans since the pandemic began in 2020. This resulted in 91 million Americans receiving Medicaid as of September 2022.
The Omnibus package passed in December ends the Public Health Emergency as of April 1st which will trigger a review of Medicaid coverage for current recipients. Experts estimate that millions of Americans will lose Medicaid coverage because of paperwork issues and others will become uninsured even though they qualify for affordable coverage under the ACA. The Omnibus sought to prevent these issues by creating federal guardrails and incentives for states as they conduct the Medicaid “unwinding” process. By statute, these protections begin April 1, 2023. If the Gurthrie bill is passed before April, these protections will be nonexistent.
What Comes Next
Republicans are looking to move Representative Guthrie’s bill through committee on Monday and bring it to the floor later in the week. The passage of this legislation would drastically hasten state plans to unwind Medicaid coverage and lead to even more Americans losing their Medicaid coverage who still meet all the criteria for coverage, and leave others without coverage who qualify for low-cost ACA coverage.
The legislation introduced by Guthrie aims to circumvent guardrails put in place by the Omnibus package, but no matter what, states can begin terminating beneficiary rolls in April of this year. If guardrails remain in place though, there are tools available to support the unwinding process.
- On January 27th, CMS released guidelines outlining a new special enrollment period for individuals leaving Medicaid or CHIP. This would allow those no longer receiving Medicaid coverage due to roll terminations to enroll in marketplace coverage outside of the open enrollment period. According to CMS, this SEP will last from March 31, 2023 to July 31, 2024.
- States can obtain temporary waivers through CMS to renew Medicaid coverage based on a wide variety of formulas that allow for individuals who may see their coverage terminated in April to continue having coverage for at least another 12 months. CMS has already approved over 158 waivers in 41 states.
- CMS has outlined guidance for states to work with MCOs, community health centers, navigators, and other programs to help streamline updating enrollee information, potentially preventing Medicaid beneficiaries whose documentation has fallen through the cracks since 2020 to continue receiving coverage. Currently, around 39 states have reported plans to work with these stakeholders and agencies.
- Under the 2022 Omnibus package passed in December, the HHS now also has the authority to forbid states from terminating beneficiaries for purely administrative reasons, and impose monetary penalties on states who do so.
What’s at Stake
If this legislation were to become law and states proceed with Medicaid unwinding absent of guardrails, up to 15 million Americans could lose their Medicaid coverage. This would be the single greatest loss of Medicaid coverage in American history, vastly outpacing even the record fall in Medicaid coverage under President Trump in 2018 and 2019. The bill brought by Representative Guthrie would worsen health disparities due to preventable losses in health coverage.
- The uninsured rate during the COVID-19 pandemic fell to an all-time low, thanks in part to the Biden administration’s historic accomplishments in his first two years in office. If current Medicaid enrollees lose their coverage and cannot access a different form of health insurance, the uninsured rate could begin to increase once again as systemic barriers exist for those leaving Medicaid while still seeking coverage.
- Of those at risk of losing coverage, over 5 million are Latinos, 2 million are African American, and a million are Asian American or Pacific Islander. In all, 13 percent of all Black children, 12 percent of Native American and Latino children, and 10 percent of all Hawaiian Native and Pacific Islander children are at risk of losing Medicaid coverage completely. Studies show only 21 percent of children who lose Medicaid ever transfer over to S-Chip.
- Many states have not updated their enrollment systems to accommodate disabled Americans or those with limited English proficiency. Currently, 19 states only provide information in English and 11 states provide no reasonable modifications, such as braille, for their online Medicaid services. Traditionally marginalized groups along lines of income will see disproportionate effects due to the lack of these services, as individuals without caregivers or guardians may lose coverage for no fault of their own.