“I am very concerned,” Gregory Hopkins, executive director of the Community Health Centers of Greater Dayton, said about the end of the public health emergency. With continuous Medicaid coverage one of the measures enacted under the public health emergency, Hopkins expects to see an impact among patients and operations.
“When 60% of our patients are on Medicaid, that’s a big chunk of our patients,” Hopkins said. “If those patients are all of a sudden unenrolled and become uninsured for even a short period of time, it’s an impact on their health and our revenue. We know patients won’t come to the doctor as often as they should if they don’t have insurance coverage.”
The White House said public health and national emergencies are currently set to expire on March 1 and April 11, respectively, and the Biden administration’s current plan is to extend the emergency declarations to May 11, ending both emergencies on that date. This wind-down would align with the administration’s previous commitments to give at least 60 days’ notice prior to termination of the public health emergency, the White House said.
Emergency SNAP ending in February
Emergency food assistance allotments are already set at the end of February in Ohio. The Ohio Department of Job and Family Services announced that changes in federal law meant that February will be the last month of emergency Supplemental Nutrition Assistance Program (SNAP) allotments.
The emergency SNAP allotments allowed households to receive the maximum allotment for their household size. Beginning in March, recipients will receive only their one, normal monthly payment.
SNAP clients should check their mail and respond to renewal letters or requests for information immediately to stay up-to-date on allotments and their eligibility, said Reba Chenoweth, public information officer for Human Services at the Montgomery County Job Center.
“Montgomery County is now working with community partners, the faith community, and other agencies to ensure this information gets to clients who may be impacted and to connect them with additional resources that they may still be eligible for,” Chenoweth said.
Continuous Medicaid enrollment to end
At the start of the pandemic, the Families First Coronavirus Response Act included a temporary requirement for Medicaid programs to keep people continuously enrolled and, in exchange, states received enhanced federal funding, which was a 6.2% increased federal medical assistance percentage.
The continuous enrollment provision under Medicaid will end following the end of the public health emergency, and the state of the Ohio is currently planning on resuming routine eligibility operations on Feb. 1.
“We have been actively working with our patients to see if they’re still eligible,” said Gina McFarlane-El, CEO of Five Rivers Health Centers. Five Rivers Health Centers is the 10th largest federally-qualified health center in Ohio, seeing more than 27,000 patients a year. Patients who may be without insurance coverage will be able to apply for a sliding fee scale at Five Rivers Health Centers, but McFarlane-El said they are working to inform patients on how to re-enroll.
In December 2022, Congress passed the Consolidated Appropriations Act, which provided that the continuous coverage provision that prohibited states from disenrolling members from Medicaid will expire on March 31. With Ohio resuming routine eligibility operations on Feb. 1, the first round of termination letters are planning to be mailed to those who are no longer eligible beginning in April.
“It has huge implications for our patients,” Hopkins said. He said that while they knew the public health emergency had to end at some point, it still feels sudden. The Community Health Centers of Greater Dayton are still not back to the number of visits they had prior to the pandemic, and pediatric immunizations are still down.
“Our patient visits are still down from 2019,” Hopkins said.
This also presents risks to individuals’ health. If they are faced with additional costs, they may not seek care.
“Health Centers are here to provide care regardless of the ability to pay, but we know, even with that safety net in place and the sliding fee scale we offer, for example, we know people just will seek care at a lower rate when they don’t have insurance coverage. Especially if they have been used to having it,” Hopkins said.
The Montgomery County Family Assistance Division will begin conducting full eligibility redeterminations beginning on April 1, according to Chenoweth. Terminations for individuals who are no longer eligible will begin on April 1, with coverage ending April 30 at the earliest. Federal guidelines provide states up to 12 months to initiate and 14 months to complete eligibility renewals, so not all terminations will take place on April 1.
“We are reminding clients that if the adults in their household are determined to no longer be eligible for Medicaid, their children may still be eligible for coverage under the Children’s Health Insurance Program (CHIP),” Chenoweth said.
Medicaid/CHIP grew by 27%
Enrollment in Medicaid and Children’s Health Insurance Program (CHIP) grew to 90.9 million in September 2022, which was an increase of 19.8 million or more than 27% from enrollment in February 2020, according to the Kaiser Family Foundation. The foundation estimated that enrollment growth that was expected prior to the pandemic was approximately 4%.
An analysis from the Kaiser Family Foundation estimates that between 5-14 million people will lose Medicaid coverage once the continuous enrollment provision ends during the 12-month unwinding period. That is a total enrollment decline by 5% up to a decline of 13%.
The lower estimate accounts for factors like new people enrolling in the program, as well as people disenrolling then re-enrolling in the program within the year, said the foundation. Its higher estimate reflects total disenrollment and does not account for churn or new enrollees. Medicaid enrollment churn is the temporary loss of Medicaid coverage where enrollees disenroll and then re-enroll within a short period of time.
The Kaiser Family Foundation estimates that the end of the COVID-19 public health and national emergencies could impact coverage, costs, and payment for COVID-19 testing, treatments, and vaccines. For people without insurance, there will no longer be a pathway through Medicaid for free COVID-19 testing, vaccines, or treatment. Privately held insurance could also incur costs.
Coverage for telehealth visits were also expanded under the public health emergency. In regard to Medicare, for example, over 28 million Medicare beneficiaries used telehealth during the first year of the pandemic, and telehealth accounted for 12% of all services used by beneficiaries during the first year of the pandemic, according to the Kaiser Family Foundation. If there are not permanent changes to Medicare coverage, most Medicare beneficiaries will lose access to coverage of nearly all telehealth services after 2024, with some exceptions like audio-only mental health and substance use services.
The Associated Press contributed to this story.
Information for Medicaid members
The Ohio Department of Medicaid encourages enrollees to keep their contact information up to date, including their mailing addresses so they receive notices to renew coverage.
You can update your contact information by calling 1-844-640-6446 Monday through Friday between 8 a.m. and 4 p.m., as well as by visiting your county department of Job and Family Services or going online through the Ohio Benefits Self-Service Portal at https://ssp.benefits.ohio.gov.
If you lose coverage and need help understanding your options, navigators are available through Get Covered Ohio for free assistance. Go to getcoveredohio.org or call 1-833-628-4467 for more information.