This article originally appeared in CQ Roll Call on February 15, 2023.
Health plans and hospitals are encouraging the Biden administration to help prevent coverage lapses once the COVID-19 public health emergency ends on May 11.
At the start of the pandemic, Congress passed a law (PL 116-127) that gave states federal funding in exchange for keeping Americans continuously enrolled in Medicaid throughout the pandemic. The provision increased Medicaid enrollment precipitously, driving down the uninsured rate.
Now, as many as 14 million Americans could lose coverage when the Biden administration ends the COVID-19 public health emergency, as states begin to kick people off their Medicaid rosters.
Several Democratic-led states are taking steps to keep residents insured, but some red states are looking to purge their Medicaid rolls and the Children's Health Insurance Program quickly to save money. Public health experts and advocates are preparing for the uninsured rate to skyrocket in those states.
The administration has proposed a policy to make things easier for low-income individuals in red states who are suddenly uninsured.
The policy, tucked into the proposed 2024 rules for the health insurance exchanges, would give Medicaid and CHIP enrollees more time to sign up for insurance on HealthCare.gov after they lose Medicaid or CHIP.
Usually, the special period for re-enrolling in health insurance coverage is 60 days, but the proposed 2024 Notice of Benefit and Payment Parameters would extend that period to a total of 150 days — 60 days before and 90 days after losing coverage — to opt into marketplace coverage because of the coming end of the emergency.
The Federation of American Hospitals wrote to the Centers for Medicare and Medicaid Services that it expects increased "consumer reliance on the Exchanges for coverage in the coming years” and the Pharmaceutical Research and Manufacturers of America called the proposals "timely" given the coming unwinding of the public health emergency.
The proposal also would change the effective coverage date for people who report future coverage loss and allow an entire family to enroll in coverage when just one person becomes eligible.
“This extended timeframe will serve as an additional safety net for individuals newly navigating tax credit eligibility and commercial plan options,” the National Association of Insurance Commissioners, which represents all 50 states, said in its comment on the proposed rule.
The Biden proposals would go into effect in January 2024 at the earliest and the administration plans to end the public health emergency on May 11 of this year. CMS required states to develop plans for the unwinding process, and 41 states have said they would take 12 months to complete.
Consumers who lost Medicaid or CHIP coverage and apply for marketplace coverage between March 31, 2023, and July 31, 2024, will receive a special enrollment period to select a plan, the Centers for Medicare and Medicaid Services clarified in guidance last month.
But some health plans say the agency needs to move faster.
The Blue Cross Blue Shield Association said that CMS needs to begin offering an extended special enrollment plan selection time as soon as possible and not wait until January 2024.
This extended open enrollment period is too long for both consumers and plans, BCBSA argues, because consumers will only seek coverage when they decide they need health care and that could promote coverage gaps.
The extended enrollment deadline could also confuse plans, BCBSA said in its comment letter, arguing that plans were not anticipating an extended open enrollment period when pricing either of their 2023 products.
The Association for Community Affiliated Plans also pushed CMS to consider finalizing an earlier effective date only for consumers who attest to a future loss of Medicaid or CHIP coverage.
Under current rules, the HealthCare.gov exchanges are already permitted to grant special enrollment periods in exceptional circumstances, and those could be longer than the 60- and 90-day periods noted in the proposal, Families USA noted in its comments.
The consumer advocacy group asked the agency to clarify that the proposed Special Enrollment Periods are minimum national requirements and that the exchanges could extend them further.