MM Curator summary
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[MM Curator Summary]: More details on one state’s plan to triage the redetermination experience for members based on a calculation of the impact it will have on each member (and their family if in a Medicaid household).
Clipped from: https://news.bloomberglaw.com/health-law-and-business/women-chronically-ill-shielded-as-oklahoma-medicaid-checks-near
Examination equipment hangs on the wall in a hospital’s trauma exam room.
Photographer: Daniel Acker/Bloomberg
Mothers, children, and patients with chronic health conditions will be last to lose Medicaid coverage in Oklahoma once checks on income eligibility resume in the spring.
The initiative from the Oklahoma Medicaid Authority aims to take advantage of the Biden administration’s 14-month window for eligibility checks by evaluating Medicaid beneficiaries based on need, targeting people who rarely use Medicaid services early in the unwinding schedule while delaying the cancellation of coverage for vulnerable populations.
Since the start of the Covid-19 public health emergency, state Medicaid programs have been prevented from conducting income eligibility checks as a part of a continuous enrollment provision passed by Congress that required states to keep beneficiaries enrolled in order to receive federal matching funds. The Consolidated Appropriations Act (Public Law 117-328) signed in December by President Joe Biden effectively did away with that provision, allowing states to resume eligibility checks after March 31.
The initiative is one of several “population prioritization” plans introduced in states aiming to soften the blow of the redetermination process, which could see an estimated 6.8 million “churn” in and out of Medicaid eligibility and another 8.2 million exceed program income limits over the long term. Nearly 300,000 of those individuals are likely to come from Oklahoma.
The Sooner State’s Medicaid enrollment has grown from about 808,000 in the early months of the Covid-19 pandemic to more than 1.2 million. The state added nearly 290,000 members since it expanded its Medicaid program in July 2021.
Although several states, including Utah and California, have introduced phased redeterminations based on individuals’ Medicaid use, Oklahoma takes things a step further by introducing a risk-based approach to redetermining Medicaid eligibility. According to the state’s plan, each Medicaid case will be processed and evaluated based on the level of burden imposed on a beneficiary if coverage were lost.
People with children under 5, those with chronic health conditions, and those with higher financial needs will see their individual cases evaluated near the end of the 14-month unwinding window, while those with no children, lower financial needs, and no recent claims will be evaluated earlier.
In the case of families with varying levels of needs, the state will disenroll children and parents at the same time, Traylor Rains, Oklahoma Medicaid director, said in January testimony before the Medicaid and CHIP Payment and Access Commission.
“If there is a family and they have different circumstances that would put them in a different bucket towards unenrollment, we are combining that case,” Rains said. “So let’s say Mom doesn’t have a severe need but the child does. We are putting that together as a case so they would unenroll at the same time.”
Minimizing ‘Needless Loss of Coverage’
Oklahoma’s unwinding strategy gives the most vulnerable populations enough time to prepare for eligibility checks, reducing the risk of coverage loss due to administrative snafu, Katherine Hempstead, senior policy adviser at the Robert Wood Johnson Foundation, said in an interview.
“A lot of these programs are really trying to minimize needless loss of coverage, especially for groups for whom an interruption of coverage would be the most consequential like children, disabled people, and those in an episode of care,” she said.
Oklahoma’s operation plan also lays out a strategy to actively coordinate and refer those who have lost coverage to the Obamacare marketplace. In the event that private insurance is unattainable, the state plans to work with a coalition of charitable clinics and safety-net providers to provide continuity of care.
One such network is the Health Alliance for the Uninsured, which serves 535,000 Oklahomans without health insurance. Jeanean Yanish Jones, executive director of the alliance, said the state’s partnership will be essential in weathering the storm of coverage loss once the income eligibility checks are completed.
“Safety-net providers, like the free and charitable clinics represented by Health Alliance for the Uninsured, are resilient and can absorb many of these patients if additional resources are provided,” she said in a statement to Bloomberg Law. “In Oklahoma, we have 94 free and charitable clinics statewide that stand ready to serve however they can provide access to healthcare for our most vulnerable populations.”