• How practices can prepare for the post-PHE Medicaid "unwinding"

    During the COVID-19 public health emergency (PHE) states have received additional federal funds with a requirement to keep people enrolled in Medicaid. Beginning April 1, though, the continuous coverage protection was lifted, and states could resume reviewing Medicaid eligibility and disenrolling individuals who are no longer eligible. This “unwinding” process will last more than a year in many states, and millions of individuals, including more than 6 million children, are at risk for a disruption in coverage. Here’s what you can do to help your patients with Medicaid coverage, and help your practice manage the transition.

    When the COVID-19 public health emergency (PHE) expired May 11, many temporary policies initiated in response to the pandemic ceased or began to be phased out. This series intends to help practices weather the transition:

    To help your patients with Medicaid:

    • Remind patients to update their contact information with their state Medicaid agency and/or managed care organization(s). Failing to respond to a request for information during an eligibility redetermination may cause patients to lose their coverage, even if they are still eligible.
    • Alert patients to check their mail for renewal notices (not everyone will get one; some Medicaid enrollees will be automatically renewed) and complete and promptly return any required paperwork.
    • Refer patients to assistance resources and post/hand out information about how to get help with renewals or re-enrollment if patients have lost coverage.

    To help your practice:

    • Ensure that intake, reception, and billing staff are aware of what is happening.
    • Get copies of state notices that eligibility determinations are resuming, so staff can become familiar with what is being communicated to patients.
    • Make sure staff are also familiar with disenrollment notices, so they can help patients understand if they lost coverage for procedural reasons or because they are no longer eligible.
    • Work with your state AAFP chapter to identify all options for patients to report updated contact information and to identify consumer assistance resources.

    For more information, check the following resources from the Centers for Medicare & Medicaid Services (CMS):

    • Medicaid.gov unwinding homepage: A centralized location where you can learn more about the unwinding and access resources to help you plan and prepare.
    • Medicaid and CHIP renewals page: A guide to help Medicaid and Children’s Health Insurance Program (CHIP) enrollees prepare to renew their coverage, including state-specific info.
    • CMS unwinding special enrollment period FAQ: Information on the temporary Exceptional Circumstances Special Enrollment Period (SEP) that allows consumers who lose Medicaid or CHIP coverage due to the unwinding process to purchase insurance on Healthcare.gov or a state-based Marketplace.
    • Anticipated state timelines for initiating unwinding-related renewals (as of 02/24/2023): This chart details the expected first month for each state/territory's unwinding-related renewals, as well as the anticipated effective date for the first procedural terminations.

    — Kent Moore, AAFP Senior Strategist for Physician Payment

    Posted on April 17, 2023 by FPM Editors

    Disclaimer: The opinions and views expressed here are those of the authors and do not necessarily represent or reflect the opinions and views of the American Academy of Family Physicians. This blog is not intended to provide medical, financial, or legal advice. All comments are moderated and will be removed if they violate our Terms of Use.