As payers prep for a PHE wind down, most Medicaid beneficiaries don't know coverage will end 

The expiration of the federal COVID-19 public health emergency will trigger a nationwide Medicaid redetermination process, but most Medicaid members are unaware their health coverage could eventually end — and payers largely aren't getting the word out.

In a survey released Nov. 15 by the Robert Wood Johnson Foundation, 62 percent of Medicaid members or those with family enrolled said they have heard nothing about future Medicaid redeterminations.

Of those who are aware of the potential coverage loss, 34 percent said the information came from the media, 31 percent said it came from their state, 25 percent said it came from their health plan and 18 percent said it came from their care provider. In addition, only half of those who were notified by their state or health plan said there was a notification to renew coverage.

The nation has been under continuous Medicaid enrollment since early 2020, which allowed 17.7 million people to gain coverage — a 25 percent increase in the program. Once the PHE ends, states will begin determining who is and is not eligible for Medicaid, and up to 15 million people could be disenrolled.

According to analysts at Fitch, payer losses from millions of disenrolled beneficiaries could be mitigated through the Inflation Reduction Act's extension of ACA premium tax credits through the end of 2025, which will allow some to regain coverage in the individual market.

The nation's largest payers have all recently announced plans to majorly expand ACA offerings in 2023, including UnitedHealthcare, Elevance, Aetna, Cigna and Centene — it's also why they're investing heavily in the transition.

"Internally, and also through partnerships with the states and regulators, we want communication out there to our existing Medicaid members and to those who could get redetermined off," Marcus Robinson, UnitedHealthcare's SVP of individual and family plans, told Becker's. "We want to do a good job of a soft landing or catching of those Medicaid members that could be redetermined off."

The recent announcement by Biden administration officials to extend the PHE past January may have been unexpected for insurers, as UnitedHealth Group executives told investors Oct. 14 they thought the PHE would end in January. Though no official end date has been given, it could be as early as April 2023.

CMS also said Aug. 26 it is investing close to $100 million to help minority individuals and those in underserved communities find and enroll in ACA plans, Medicaid and CHIP.

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