States have started disenrolling members from Medicaid for the first time since 2020 as pandemic continuous coverage requirements come to an end.
Experts have said the process is going worse than expected, and more than 1 million people have been disenrolled so far.
Here are 10 key updates on redeterminations and other Medicaid policy changes from the first half of 2023:
- The nation's retail pharmacy giants are playing an important role in Medicaid redeterminations through payer-agnostic outreach and education initiatives aimed at customers and employees in all 50 states. Here's how CVS and Walgreens are educating customers about the process.
- As of June 12, more than 1 million people have been disenrolled from Medicaid as part of the redeterminations process, according to KFF. Around half of those disenrolled live in Florida, Arizona and Arkansas.
- Medicaid work requirements were not included in a debt ceiling deal between President Joe Biden and House Speaker Kevin McCarthy. House Republicans included work requirements in an April bill to raise the debt ceiling into next year. Under the proposal, most Medicaid beneficiaries aged 19-56 would have needed to work, volunteer or be part of a work program for 80 hours per month to be eligible for coverage.
- CMS proposed a new rule for drug manufacturers, pharmaceutical benefit managers and managed care plans to increase drug price transparency in Medicaid. In a proposed rule published May 23, the agency laid out plans to increase transparency by requiring manufacturers to disclose some pricing information through a price survey and requiring PBMs to disclose more pricing details to managed care plans.
- With Medicaid redeterminations underway, health policy experts said too many people in some states are losing health coverage for the wrong reasons. In Florida, nearly 250,000 individuals were disenrolled from the state's Medicaid program in May, but 82 percent of those disenrolled saw their coverage terminated because their information was not updated with the state.
- Most private payers do not cover new drugs meant to treat obesity, but Medicaid programs in a few states do. Ten states offer broad coverage of weight loss drugs, and others offer limited coverage.
- CMS proposed two new rules in April that would establish national standards of care provided through fee-for-service Medicaid/CHIP and managed care plans, along with a requirement to publicly disclose provider payment rates online.
- Reduced Medicare and Medicaid payments are having more physicians considering reducing those patient bases, according to Medscape. Sixty-five percent of physicians surveyed said they would continue treating current Medicare or Medicaid patients and take on new ones, according to the report. Medscape said it is the lowest percentage it has seen in its annual compensation reports.
- Medicaid unwinding timelines and policies vary from state to state. Here's when each state will begin disenrolling Medicaid beneficiaries, and here's how many people could lose coverage state-by-state.
- The number of adults in a Medicaid-enrolled family that are unaware of impending redeterminations remains high across the nation. According to a survey conducted in December 2022 and published Feb. 15 by the Robert Wood Johnson Foundation, 64 percent of Medicaid members or those with family enrolled said they have heard nothing about upcoming redeterminations. In June 2022, the same survey found 62 percent of adults had no knowledge of Medicaid renewals.