Medicaid directors face myriad challenges going into the fall, most of which are related to the COVID-19 pandemic.
They're working to encourage recipients to get a coronavirus vaccine, turning to behavioral and population health programs more in need now than ever and preparing for the eventual end to the public health emergency.
The challenges come amid record enrollment and a pledge from President Joe Biden's administration to do more to get people on the rolls by expanding coverage in areas like postpartum services and in the dozen of holdout states that have not expanded the program under the Affordable Care Act.
Lagging COVID-19 vaccination rates among the Medicaid population remain the biggest challenge right now, said Dave Richard, deputy secretary of Medicaid for North Carolina's Department of Health and Human Services during a Wednesday panel at AHIP's annual conference on Medicare, Medicaid and dual eligibles.
Not all state Medicaid programs track vaccination rates, but some do. In Florida, 34% of Medicaid recipients are at least partly vaccinated, compared with 67% for all residents 12 and older, according to an August analysis from the Kaiser Family Foundation.
In Louisiana, 26% of Medicaid enrollees are at least partly vaccinated, compared with 59% for the state population, according to that analysis.
And that's despite the fact the Medicaid members tend to be those at most risk for severe disease from the coronavirus. Medicaid members with low incomes often suffer from chronic health conditions that make the virus pose a greater risk to them than other populations.
Incentivizing hold-outs to get the shot has been effective in Georgia and is an opportunity for managed care organizations to step up to the plate, "whether that's something as simple as a gift card or over the counter medications," Lynnette Rhodes, executive director of medical assistance plans for Georgia's Department of Community Health said during the panel.
Another persistent challenge for state Medicaid directors is dealing with the social determinants of health that affect their beneficiaries, and figuring out the role MCOs can play in offering solutions.
Housing vouchers or other resources that help make the transition from an institutional to a community setting can help fill the gaps, "with managed care partners being critical to that equation," said Jennifer Langer Jacobs, assistant commissioner for the division of medical assistance and health services at New Jersey's Department of Human Services.
And referring a member to a community resource for housing, food, or other services is one thing, but making sure they use those services is still an issue, Rhodes said.
"I think one big area of concern is also making sure we're closing the loop," she said.
Looking ahead, state Medicaid officials have two other key hurdles tied to the pandemic and its eventual end.
Policymakers are still mulling how many telehealth flexibilities should be allowed after the public health emergency expires and what services should be covered for Medicaid beneficiaries.
At the same time, the federal public health emergency will eventually end along with the Medicaid continuous enrollment requirement tied to pandemic relief legislation that ceased typical churn.
One in four Americans are currently covered by Medicaid, "but that's not going to last forever," Matt Salo, executive director of the National Association of Medicaid Directors, said.
Redeterminations and other processes will be heavy lift for resource-strapped state Medicaid departments. CMS extended the timeframe states have to complete those actions once the PHE ends, though concerns remain that eligible beneficiaries could lose coverage if states are unable to complete workloads in a timely fashion.
But those beneficiaries will need coverage more than ever with some suffering from long-haul COVID-19, pent up demand due to delayed care and worsened conditions because of the care they put off.