News Release

End of Federal State of Emergency Could Mean Catastrophic Medicaid Results

Last month, Politico, Bloomberg, and other outlets amplified a report from the Urban Institute––“What Will Happen to Unprecedented High Medicaid Enrollment after the Public Health Emergency?”––which found that 15 million people, including 6 million children, could potentially lose health insurance when the federal public health state of emergency (PHE) ends. On March 10, journalist Libby Watson called further attention to the issue in the Daily Poster article “The Coming Medicaid Purge.”

States are required to keep people enrolled in Medicaid throughout the PHE as a condition of receiving a temporary increase in the federal share of Medicaid costs. Enrollment surged nearly 20 percent during the pandemic, to an all-time high.

The PHE has already been extended several times, and is currently set to expire on April 15 of this year. Watson notes that “the PHE is likely to continue until July or later, but could end as soon as April. That means that even though the Centers for Medicare and Medicaid Services (CMS) has given states up to 14 months to resume redeterminations, states are likely already preparing to slash their Medicaid rolls enough to offset the coming loss of federal funding.” Watson reports that a right-wing campaign is pushing an end to the PHE and calling on states to begin disenrolling people immediately, and that the transition period may serve as a “gold rush” for private contractors and consulting firms. 

LIBBY WATSON, sicknotenewsletter@gmail.com, @libbycwatson [email and text preferred]
    Watson is a journalist and the author of Sick Note, a newsletter about American healthcare. 

When the PHE does end, nearly all 80 million enrolled in Medicaid will undergo eligibility redetermination. The authors of a Commonwealth Fund article from September 2021 on coverage loss write that redetermination will trigger “a high risk of coverage losses that is almost certain to fall disproportionately on Black and Latinx individuals who have experienced significant harm and dislocation during the pandemic.” Other reports, including one from the Georgetown University Health Policy Institute, estimate that at least 6.7 million children will be likely to lose coverage and are at considerable risk for becoming uninsured for some period of time.

Recent reporting from David Perry in GRID News points to possible avenues for the Biden administration to keep people covered and avert the crisis. Perry notes that Bethany Lilly, director of income policy at The Arc, said that the Centers for Medicare and Medicaid services (CMS) can pressure states to prioritize the most vulnerable people by assessing their eligibility as late as possible. Lilly spoke directly to the Institute for Public Accuracy, saying, “It’s crucial for policy makers to have adults and children with disabilities front of mind as HHS and states work to plan for the upheaval to come. Medicaid isn’t just a matter of health care for people with disabilities, it’s also the services that help people live independently in their communities and go to school.” 

Other experts suggest that CMS could also extend the length of time that states have to process eligibility. Since many states have an incentive to process quickly, the best alternative might be to extend the federal PHE.