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Getting the Medicaid program through the period after the COVID-19 public health emergency (PHE) ends -- a time when some Medicaid beneficiaries will lose their eligibility -- will not be easy, Medicaid officials from several states said Tuesday.

"This is not going to happen overnight," Amanda Cassel Kraft, Assistant Secretary for MassHealth at the Massachusetts Executive Office of Health and Human Services, said at a webinar sponsored by the Kaiser Family Foundation. "States have about a year to initiate eligibility renewals, and we've got a whole lot of members to go through the process."

"Part of the balance that we're trying to strike is getting out the message far and wide, and as clearly and simply as we possibly can, about the process and the need for members to respond when they do receive renewals," she said. "But also understand that it's not as if all 2.3 million of our members are going to receive requests to renew their eligibility on day 1 of the end of the PHE and they're all going to be acting at the same time. This is going to be an extended process, and it's going to require an ongoing kind of attention and partnership with our providers, and our advocacy organizations, and our community organizations around the state to continue to reach out to members, and for folks to respond to that envelope when it does come, even if that is 7 months into the process."

Allison Taylor, Medicaid director for Indiana, noted that "One message that can be difficult is that when we do go through redetermination, there are folks that are going to be no longer eligible for coverage. And so balancing that [means] making sure there's a warm handoff and members are ready and have plans."

"There will be some appropriate, thoughtful disenrollment along the continuum," said Taylor, who is also president of the National Association of Medicaid Directors. "We want to do that very thorough eligibility process, but we also recognize that coverage will look different -- we will have lower levels of coverage on the back end, as would be expected."

Both Massachusetts and Indiana have seen big increases in enrollment during the pandemic, according to Kraft and Taylor. In Massachusetts, "pre-pandemic, we were at about 1.8 million members and currently we're at 2.3 million members," Kraft said. "So that's nearly a 30% increase as a result of the 'maintenance of effort' requirements during the public health emergency." The program covers about 40% of children in Massachusetts and about 60% of individuals with disabilities, she added.

In Indiana, "we've seen tremendous enrollment growth," said Taylor. "We typically had around 1.4 million Hoosiers in Medicaid; right now we're well over 2 million as the maintenance of effort continues." About 85% of the state's Medicaid program is run through managed care, she said.

The webinar was held in conjunction with the release of a which noted that "nationwide, Medicaid provided health insurance coverage to in 2020 and accounted for nearly of all U.S. health care expenditures in 2020." The report also found that "total Medicaid/CHIP [Children's Health Insurance Program] to 89.4 million in June 2022, an increase of 18.2 million (25.6%) from February 2020, right before the pandemic, when enrollment began to steadily increase."

"When the PHE ends, states will begin processing redeterminations and millions of people could lose coverage if they are no longer eligible, or face administrative barriers despite remaining eligible," the report said. "Some unwinding of PHE emergency authorities is already completed or underway. The temporary 6.2 percentage-point increase in federal matching funds will expire at the end of the quarter in which the PHE ends."

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