National Public Health Emergency to Last Until At Least October - Route Fifty

State Medicaid administrators will have at least until the fall before having to begin the mammoth task of reassessing whether every resident who receives the low-income health care coverage can continue to get help.

In addition, millions of people who are receiving additional food stamp benefits will get the extra assistance until at least October, after a deadline passed this week for U.S. Health and Human Services Secretary Xavier Becerra to tell states that he is ending the nation's Covid-19 public health emergency.

"As HHS committed to earlier, we will provide a 60-day notice to states before any possible termination or expiration," an HHS spokesman said on Friday.

The end of the emergency will have major ramifications for Medicaid and the Supplemental Nutrition Assistance Program. 

The Families First Coronavirus Response Act, passed by Congress in March 2020, gave states greater flexibility to let more people receive food stamp benefits. It also increased the benefits many recipients received by about $82 a month. The law also waived a three-month limit on unemployed, childless adults younger than 50 accessing the safety net program.

But all that ends whenever Becerra lifts the Covid-19 public health emergency.

Also ending will be the increased federal assistance states are getting for Medicaid, after Congress boosted the Federal Medical Assistance Percentage, or FMAP, by 6.2%. The move was a response to people losing health care coverage in the early days of the pandemic. 

But in return for the extra money, also approved in the families first act, states were barred from removing anyone from their Medicaid rolls. 

When the emergency ends, state Medicaid directors will have to reevaluate within 14 months who among the roughly 80 million program participants still is eligible.  Some administrators say they will be under pressure to move quickly to remove ineligible people because the roughly $90 billion a year in increased federal Medicaid funding states have been receiving will stop.

There was a chance the emergency could be lifted in July. Becerra on April 15 extended the emergency another 90 days, and promised he would give states 60 days notice before he ends it, which would have come the past week.

"Our understanding now is that the [public health emergency] will be extended again, and we assume it will be for another 90 days," said Matt Salo, executive director of the National Association of Medicaid Directors, said in an email. That would extend the emergency until at least October. "Whether that's the last one or not is still unknown," he said.

"Part of the challenge of administering the Medicaid program through the past two years has been the built-in uncertainty surrounding many aspects of the pandemic, including the length of the PHE," he added. "It makes it difficult to effectively plan, but we certainly understand there are many complicated factors that go into the decision, and we will be ready to implement the 'unwinding' in October."

Time to Plan

The liberal Center on Budget and Policy Priorities noted in a report that the absence of a notice from Becerra gives states "at least five additional months to prepare." States "should take steps now to ensure that eligible individuals remain on Medicaid and to help those no longer eligible for Medicaid transition to other coverage," the report said.

States should inform Medicaid recipients that their coverage needs to be renewed and explain the steps they must take to complete their renewals, the report said, and "conduct streamlined renewals for all Medicaid enrollees, including conducting automated renewals where possible." And for those who are removed from the system, states should prepare to help them find other coverage.

Several states are taking innovative approaches, the report said. Arkansas, for instance, has set up a call center to reach out to Medicaid enrollees and help them update their contact information.

Kansas conducted a social media campaign encouraging Medicaid enrollees to contact the state to update their information and household circumstances. The campaign led to a 15% to 20% increase in enrollees updating their contact information, the report said.

New Mexico provided $35 million to assist people who are no longer eligible for Medicaid to get subsidized coverage on the Affordable Care Act marketplace.

And Tennessee has conducted a digital ad campaign through Facebook, Instagram and Google Search that more than doubled the number of enrollees who completed their renewals and led to the creation of 16,000 new online accounts in three months, the report said.

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