Planning for the end of pandemic-era Medicaid coverage

Beat Memo

This past weekend brought the end of continuous Medicaid coverage, under a Covid-related policy that prohibited states from removing any enrollees from their Medicaid rolls.

The result? An estimated 15 million of the nation’s 92 million Medicaid enrollees will lose coverage over the next 14 months, including roughly 7 million who are actually still eligible due to “administrative churning.” The unwinding must be completed by the end of May 2024.

The process to re-determine eligibility will be a massive undertaking for state and local governments: New York is embarking on the process of reviewing more than 9 million people across the state who are enrolled in Medicaid, Child Health Plus and the Essential Plan to see whether they still qualify for government-sponsored insurance.

New York state officials estimate that about 52,000 people will shift from Medicaid to Child Health Plus, 46,000 will move to the Essential Plan, and 54,000 will enroll in qualified health plans.

Roughly 100,000 New Yorkers would be newly uninsured, according to preliminary estimates.

Medicaid enrollment would dip from about 7.8 million to under 6.5 million by next March as a result, according to those estimates, although that would still exceed the program’s pre-Covid enrollment of 6.1 million.

In New York, however, Medicaid coverage terminations won’t start until July 1, according to the state Department of Health.

Consumers are being encouraged to renew by the 15th of the month when their coverage expires. The first renewal deadline is June 30.

Before the pandemic, annual re-certifications were already a known point when many lose health coverage.

Now the stakes are even higher due to the sheer number of people going through the process at the same time.

“We know that so many people can have one medical emergency that really derails their entire life from a financial perspective,” said Erin Drinkwater, chief of government relations and strategic partnerships for insurance carrier MetroPlusHealth. “To not have that health coverage is really catastrophic.”

Drinkwater said MetroPlusHealth, which is part of NYC Health + Hospitals, has almost 339,000 members who will need to recertify eligibility before the end of this year.

The state has undertaken some efforts to prevent gaps in health coverage, such as by expanding Medicaid eligibility for New Yorkers with disabilities and those over 65.

The Department of Health is also in talks with the federal government about using IRS data to conduct auto-renewals for some Medicaid members. A spokesperson said the department is still in good-faith negotiations with the Centers for Medicare and Medicaid Services on its risk-mitigation plan for the unwind period.

“It is our top priority to reinstate eligibility reviews in a way that retains coverage for as many enrollees as possible and limits coverage gaps, particularly for vulnerable populations dependent on services,” state Medicaid Director Amir Bassiri said in a statement in March.

For New Yorkers who are no longer Medicaid-eligible, the state’s health plan marketplace — NY State of Health — will help them transition to the Essential Plan, Child Health Plus or a qualified health plan.

NY State of Health will increase its customer service center staffing to above pre-pandemic levels to handle the anticipated volume, according to a Department of Health presentation.

IN OTHER NEWS:

— The state has launched its “long-awaited” (or long-feared, depending whom you ask) transition to NYRx, a fee-for-service Medicaid pharmacy benefit program that carves prescription drug coverage out of managed-care plans, Gov. Kathy Hochul announced Saturday.

Under the new model, Medicaid will directly pay pharmacy costs instead of paying managed-care organizations to administer the benefit through pharmacy benefit managers, a type of middleman.

“The transition to NYRx today is in the best interest of those New Yorkers relying on Medicaid for affordable prescription medication,” Hochul said in a statement.

But the state Legislature has yet to pass a budget for the 2024 fiscal year, as part of which Hochul pledged $705 million in Medicaid funding to health care providers that would lose critical revenue from the 340B federal drug discount program as a consequence of the change.

Several safety-net provider organizations had filed a lawsuit in an effort to temporarily halt the carveout from taking effect, but state officials said there would be no way to do that without jeopardizing the ability of all 6 million Medicaid managed care enrollees to access prescriptions.

“Effective April 1st, the ‘switch has been turned off’ for Medicaid Managed Care plans, which will no longer have any ability to process Medicaid prescription drug claims, and any claims submitted to the Medicaid Managed Care Plans will be denied,” Bassiri, the state Medicaid director, said in an affidavit filed Friday.

ON THE AGENDA THIS WEEK:

— Monday, 10 a.m. to noon. The state Public Health And Health Planning Council hosts the ad hoc committee to support the prevention agenda at its Albany, Buffalo and New York City offices.

— Tuesday at 6 p.m. Health + Hospitals hosts its annual Manhattan public meeting for fiscal year 2023 at Harlem Hospital.

GOT TIPS? Send story ideas and feedback to Maya Kaufman at [email protected].

Want to receive this newsletter every weekday? Subscribe to POLITICO Pro. You’ll also receive daily policy news and other intelligence you need to act on the day’s biggest stories.

What you may have missed

— After city officials announced the signing of a $200 million Medicare Advantage contract with Aetna to cover roughly 250,000 municipal retirees and their dependents, some retirees held a last-ditch protest in City Hall Park, POLITICO’s Madina Touré reported.

“Now Mayor Adams tells us that this new plan will be as good or better than what we have now,” said Gloria Brandman, a member of the Cross-Union Organizing Committee. “Mayor Adams tells us this. However, Mayor Adams, we are not fools. How can a better plan that costs less money give us more? That doesn’t sound possible.”

— Mayor Eric Adams joined NYU Langone executives to cut the ribbon Friday on a five-story outpatient health care center at the site of the former Long Island College Hospital in Cobble Hill, Brooklyn.

The new facility includes a 24-hour emergency department and offers services across 19 medical and surgical specialties. It is expected to serve more than 200,000 patients a year.

“People thought that we were not going to bring back the quality care and services here to this community,” Adams said, “but it’s been proven wrong.”

Odds and Ends

NOW WE KNOW — This is what ASMR videos do to your brain.

TODAY’S TIP — Exercise could help counteract the health consequences of a bad night’s sleep.

STUDY THIS — The fruit of the cocklebur plant could have anti-aging potential, researchers find.

— “‘It’s your life, it’s your death': NYC’s end-of-life doulas are trying to make dying a little better,” Gothamist reports.

— End of Covid public health emergency could further jeopardize access to gender-affirming care, STAT reports.

— CDC team studying health impacts of Ohio train derailment fell ill during investigation, CNN reports.

— Via The Washington Post: “The tragic, preventable reasons syphilis is surging among U.S. infants.”

— A comedian’s on-stage collapse became anti-vaccine fodder, but she’s alive and joking, NBC News reports.

Around POLITICO

— Pfizer to restrict discounted pharmacy access to its blockbuster arthritis drug, Katherine Ellen Foley reports.

— Medicare Advantage plans get a win in final CMS 2024 payment rate, David Lim reports.

— Long-term financial future of Social Security and Medicare still at risk, Erin Schumaker reports.

MISSED A ROUNDUP? Get caught up on the New York Health Care Newsletter.