Medicaid redeterminations and loss of coverage

Policy crossroads and the end of the public health emergency due to COVID-19

This is part of a three-part series on significant implications of the end of the Public Health Emergency (PHE). 

What does your organization need to know?

March 31^st marked the end of the COVID-19 Medicaid continuous coverage condition. Most forecasts project between 10-15 million enrollees will lose Medicaid coverage. State Medicaid programs will lose supplemental funding provided for the continuous coverage requirement and begin to transition to normal eligibility operations. Health Management Associates (HMA) and HMA companies can help the full spectrum of stakeholders plan for, adjust to, and administer the changes up to and beyond the 12-month continuous coverage “unwinding” period. The immediate work can serve as a springboard for future improvement initiatives and to respond to federal guidance that is under development to strengthen and streamline eligibility and enrollment processes and improve the experience for consumers.

Who is affected by this change?

• Payers including Medicaid managed care organizations and Qualified Health Plans
• Provider organizations
• Trade associations of Medicaid managed care or provider organizations
• State and local community-based organizations
• State and local governments responsible for administering and overseeing the eligibility processes for Medicaid and other public programs
• Advocacy groups
• Foundations
• Vendors supporting state agencies, health plans and providers

Watch a video presentation about the HMA Coverage Model

What is in the HMA model?

HMA has developed an insurance mix model that projects how the resumption of Medicaid eligibility redeterminations beginning in April 2023 will affect Medicaid enrollment, employer sponsored insurance (ESI), Marketplace coverage, and the uninsured. The model includes enrollment projections for all 50 states and considers the enhanced Marketplace subsidies included in the Inflation Reduction Act (IRA). Approximately 20 million individuals gained coverage during the redetermination freeze and well over 10 million of the approximately 90 million current Medicaid enrollees are at risk for disenrollment.  HMA’s model contemplates the variety in state approaches to managing the resumption of eligibility redeterminations as well as key insights related to the differential impact by Medicaid eligibility categories. 

HMA can help with immediate needs to help you plan:

• HMA has detailed state-specific unwinding policy insights for each state including observations regarding which states are taking more aggressive and less aggressive approaches. 
• We can provide technical assistance and strategic planning services to help states and organizations manage the necessary changes.
• Actuarial experts can assist with acuity changes caused by the change in enrollment.
• Our colleagues are available for a discussion of the product and the key policies influencing the projections.
• HMA can also help with post PHE support.

For more information, please contact:

Matt Powers, Managing Director, [email protected]

Chris Dickerson, Consulting Actuary, [email protected]