- Health centers say rolling back government actions that boosted Medicaid coverage during the pandemic after the COVID-19 public health emergency expires could severely curtail patient care, according to a new survey conducted by the National Association of Community Health Centers.
- Almost all health center respondents (90%) said due to the higher Medicaid enrollment and other regulatory flexibilities, they were able to provide more services to patients who would have otherwise gone without care, while 87% said they were able to treat more patients overall.
- But these benefits are at risk if these policies are not extended beyond the PHE, health centers said. More than 90% of respondents said the termination of Medicaid-related flexibilities will result in patients foregoing needed healthcare services. Many others said their patients would have to rely on emergency and urgent care departments for medical care instead. Repercussions for losing access to low-cost preventative care would be especially stark for patients with chronic conditions and others with high-cost medical needs, NACHC said.
Despite the COVID-19 economic recession last year booting millions of Americans off employer-sponsored insurance, safety-net Medicaid and the individual exchanges set up by the Affordable Care Act kept the nation's insurance rate steady.
CMS data shows that Medicaid enrollment alone grew by more than 11 million people — a 16% bump — from February 2020 to April 2021, spurred in part by more flexible regulations put in place during the pandemic.
As part of the Families First Coronavirus Response Act passed last March, states began receiving a 6.2% bump to the federal Medicaid match rate. In exchange for the higher federal funding, states are not allowed to disenroll any beneficiaries from Medicaid during the PHE.
That continuous coverage requirement contributed to Medicaid becoming the largest single source of insurance coverage in the U.S. But when the emergency ends, states are allowed to resume redeterminations, potentially kicking millions off the safety-net insurance.
"Unless these policies to keep people enrolled in Medicaid coverage continue or are extended, Medicaid beneficiaries will lose benefits, pay more for health care, or go without care, throwing the safety net into further peril," NACHC said, noting patients in the 12 states that have yet to expand Medicaid will be especially hard-hit.
NACHC surveyed federally qualified health centers, federally funded nonprofit provider clinics, in September to determine how losing the Medicaid flexibilities will affect their operations and their patients' health. The some-1,400 FQHCs nationwide serve nearly 29 million people, including one in five Medicaid beneficiaries and one in three low-income Americans.
Before the pandemic, 48% of health center patients were Medicaid and Children's Health Insurance Program recipients, but that increased significantly over the PHE. Most health centers reported up to a 25% increase in Medicaid patients.
Nearly all the health centers said they treated more patients who would otherwise have to turn to an ER or forego care altogether.
A third of health centers have been able to treat more children, while half say they've been able to prevent chronic conditions from occurring or becoming exacerbated. Many health centers also report telehealth, which has also benefited from more flexible regulations from Washington, was a valuable tool in reaching more patients and providing more services during the PHE.
NACHC said its health center members are worried about people with Medicaid coverage being deemed ineligible and losing insurance once states revert back to pre-COVID-19 Medicaid policies and eligibility.
The Biden administration recently extended the timeframe states have to complete pending eligibility and enrollment actions to up to 12 months after the PHE ends, and required states to complete an additional redetermination for anyone deemed newly ineligible. But that's not enough, NACHC said.
The group argues that, along with codifying telehealth flexibilities, Congress should take a number of actions to protect Medicaid coverage — many of which it's already considering.
That includes giving states more clarity about the expected phase-down of their 6.2% FMAP increase, establishing strict eligibility redetermination standards states need to follow, along with penalties for states that attempt to cut Medicaid eligibility before 2025, and strengthening ACA marketplace subsidies and enrollment periods to help people in non-Medicaid expansion states.