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[MM Curator Summary]: Forbes kindly points out that the 18M are no longer eligible and have lots of protections to help them as they exit the program for which they are… no longer eligible.
Clipped from: https://www.forbes.com/sites/theapothecary/2023/05/02/cleaning-up-medicaid-rolls-after-covid/?sh=4371c5f83003
Today, Paragon Health Institute released a new report, Pandemic Unwinding: How States Should Clean Up Their Medicaid Rolls.
Medicaid is a welfare program for low-income Americans. But, because of policies related to the COVID public health emergency, more than 20% of Medicaid enrollees no longer meet the criteria for program eligibility. States have not conducted redeterminations of Medicaid enrollees’ eligibility in more than three years.
States have an obligation to move as quickly and smartly as possible to begin cleaning up their Medicaid rolls. Doing so would represent an important first step toward rebuilding public trust, protecting taxpayers, and preserving resources for the country’s most vulnerable.
I coauthored this report with Gary Alexander, who led two state health and human services departments, and research fellow Nic Horton. The importance of Medicaid redeterminations was evidenced by yesterday’s Wall Street Journal op-ed by Arkansas Governor Sarah Huckabee Sanders entitled, “Arkansas Gets Medicaid Back to Normal.” The Paragon report provides a case study of Arkansas’s approach to redeterminations and contains seven steps that states should take to perform expedited and efficient redeterminations.
According to the Congressional Budget Office, roughly 20 million Americans have multiple sources of coverage with the most common being employer coverage and Medicaid. As a result, taxpayers are making sizeable payments to health insurers for many Medicaid enrollees who have other sources of coverage and who should not be on welfare. Moreover, public resources are being expended for people who likely need the program less than others who rely on it to pay their health care expenses.
Here are the five key takeaways from the paper:
1. The continuous enrollment requirement for Medicaid during the COVID-19 public health emergency has led to upwards of 18 million Medicaid enrollees who do not meet eligibility requirements for the program.
2. As of April 1, 2023, states have resumed regular eligibility redeterminations to preserve Medicaid for those who truly need the program and to protect taxpayers. States should prioritize resources and start with reviews of those most likely to now be ineligible.
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3. States have an incentive to act expeditiously, as enhanced federal COVID funding for Medicaid has already begun winding down and will be gone by the end of 2023.
4. The vast majority of people enrolled in Medicaid who are ineligible already have other sources of coverage or will transition to other sources of coverage when their Medicaid enrollment ends. For example, a study from the Urban Institute found that only one percent of removed enrollees would not qualify for other forms of subsidized coverage.
5. There are numerous protections for people who are removed from the program and who are still eligible, including retroactive Medicaid coverage that pays for three months of past medical expenses.
Even before the pandemic, improper Medicaid enrollment was the leading cause of improper payments in federal health programs, including Medicare. This was a problem emanating from the excessive federal reimbursement of state expenditures on Medicaid recipients enrolled under the Affordable Care Act (ACA). With University of Kentucky economist Aaron Yelowitz, I wrote about how the ACA led to significant improper enrollment and spending in Medicaid in two Wall Street Journal pieces (“ObamaCare’s Medicaid Deception” and “Why Obama Stopped Auditing Medicaid“) as well as a Mercatus research paper. Thus, there were many ineligible Medicaid enrollees when the COVID continuous coverage requirements commenced.
In the report, we discuss how rules from both the Obama and Biden administration made it more likely for ineligible people to stay on Medicaid and more difficult for states to remove ineligible recipients from Medicaid, in part by reducing the frequency of state eligibility redeterminations. Importantly, much of the media’s focus on Medicaid redeterminations fails to appreciate how easy it is for people who are eligible for Medicaid to enroll or re-enroll in the program. As we discuss in the report, two major protections are retroactive eligibility and hospital presumptive eligibility.
• Retroactive eligibility: Individuals who qualify for Medicaid can enroll and have their medical expenses covered by taxpayers retroactively so long as they were eligible when the services were received. If individuals are incorrectly removed, they can re-enroll in the program and still have their expenses covered, with up to three months of expenses paid by Medicaid.
• Hospital Presumptive Eligibility (PE): PE is an expedited Medicaid application process through the hospital that permits a Medicaid determination based on only a few questions about income and household size and without verification. If individuals meet these basic and initial requirements, they are immediately presumed Medicaid eligible. They receive temporary coverage pending completion of a full eligibility review. This means that a person who is disenrolled often finds it easy to get back on the program through PE when receiving medical services.