Thomas Ferkovic May 8, 2023 3:59:14 PM 4 min read

What to do When Your State Starts to Disenroll Medicaid Members

The headlines read that millions of people will no longer be covered by Medicaid by June 2024. That is potentially true, and it raises an important question among providers and patients alike: will the 14 to 18 million potential dis-enrollees lose their healthcare coverage altogether?

If you’re among the healthcare organizations wondering what this means for your business – and concerned about being stuck with patients’ bills that are uncollectable – you’ve come to the right place. Below, we’ll unwind the headline by reviewing the facts, plus share actionable tips to stay a step ahead of the coming changes. 

First, let’s review what we know. The Families First Coronavirus Response Act of 2020 (FFCRA) provided an enhanced federal match of 6.2% to states to help offset the increased Medicaid enrollments due to the pandemic. The original rule was designed to last until the end of the public health emergency. Then, Congress passed the Consolidated Appropriations Act of 2023 (CAA), which uncoupled the Medicaid match from the public health emergency. Individual states can now start to unwind the continuous enrollment provision and must perform a redetermination for all Medicaid beneficiaries within 14 months, or by June 2024. The estimates are that 14 to 18 million people will lose Medicaid coverage by June 2024. This ranges from Utah losing an estimated 32.5% of Medicaid eligible members, to Nebraska disenrolling 10.7%.  

On the surface, this is not good for patients, the healthcare system, or providers trying to budget revenue and volume. But let’s look deeper. 

Most states are looking to ensure continuous coverage for their residents by working with the state Medicaid agencies to help disenrolled citizens with ACA marketplace enrollment. For example, California and Rhode Island are automatically enrolling disenrolled members into ACA silver plans and using ARPA funds or state budgets to leverage the premiums on the exchanges. Twenty-two states have already created web pages that alert enrollees to changes and coverage options. In addition, in 2021 as part of the American Rescue Plan Act, Congress included temporary premium subsidies to reduce the ACA plan costs and in 2022 extended those subsidies for an additional three years in the Inflation Reduction Act.  In short, individual states have the opportunity to coordinate options between Medicaid and ACA plans to help avoid gaps in coverage. The net effect is hard to estimate, but most forecasts taking this information into account show closer to 3.5 to 5 million people being affected, as opposed to 14 to 18 million. 

Given this information, below are actionable steps you can take as an administrator to prepare:

  • Check your individual state’s plan for redetermination and minimizing the coverage gap.
  • Review what the reimbursement is for the ‘silver’ or other ACA plan(s) your state is recommending.
  • Ensure you are on panel for these plans.
  • Re-train your front desk and intake staff to make sure they review each patient’s current insurance card every visit.
  • Follow up on coverage denials immediately and obtain up-to-date insurance information.

While the full impact of Medicaid disenrollment isn’t yet fully clear, your strategy and plan can be. A proactive approach that prioritizes operations and efficiency can help offset the effects and position your business for success.