On their second day in office, the Biden administration promised to give states 60 days notice of the termination of the COVID-19 public health emergency (PHE) since there are significant consequences — especially for the operation of state Medicaid programs. The Biden administration did not provide states with a 60-day notice earlier this week, so we know it will be extended beyond its current end date of July 15, 2022 — most likely another 90-day determination to October 13, 2022.
About 80 million people — including approximately half the children in the U.S. — will have their health insurance status checked when the PHE lifts. While the Medicaid continuous coverage protections remain in effect, no one can be involuntarily disenrolled. So, this is a really big deal. We have written about the potential for as many as 6.7 million children to lose coverage if the process goes poorly.
With the new extension now assured (assuming it is a 90-day extension – discussed below), the first date for possible Medicaid disenrollments would be November 1st, 2022. And enhanced federal funding for Medicaid and CHIP (6.2% increase in federal Medicaid share/4.34% for CHIP) will continue through the end of calendar 2022.
What does this mean for Medicaid’s continuous coverage protections and when they might end?
Cynics may note that the current extension takes us to a few weeks before the midterms and suggest that the PHE will likely be extended again as a consequence. I agree that there is a decent possibility that the PHE will be extended again — though the pandemic itself may be the most important reason why. And with the Administration’s own COVID advisors predicting a troubling fall surge and new variants appearing routinely, it appears that, sadly, the likelihood of the pandemic being in the rearview mirror by then is unlikely.
The Biden administration (i.e. Secretary Becerra) terminating the PHE continues to be the most likely way the Medicaid continuous coverage provisions will end. Some are speculating that Secretary Becerra could issue a declaration for less than a 90-day period. But that seems unlikely to happen since 90-day increments are the norm and that would create another obstacle for states to plan around.
As regular readers of SayAhhh! know, it is possible that a specific state could refuse the additional federal funding that the continuous coverage protections are tied to. If a state turns down the extra federal funding, they no longer have to abide by the continuous coverage rules.
Some will no doubt push for this and some states may consider it; though many states are out of legislative session now or will be soon. There seemed to be little serious discussion of this during recent legislative sessions. And a recent report from KFF finds that the extra federal funding has definitely more than compensated states from enrollment growth associated with the continuous coverage provisions.
It is also possible that Congress could legislate and delink the end of the PHE with a phase down of the extra Medicaid/CHIP funding and a date certain to end the Medicaid continuous coverage provisions. This happened in the House-passed Build Back Better Act. Whether Congress will do that is anybody’s guess but I think that is unlikely to happen anytime soon given that there is no sign of imminent movement on the reconciliation bill.
The Medicaid continuous coverage provisions have been incredibly valuable during the pandemic. As we blogged about recently, it appears that they may have reversed the harmful trend of more children becoming uninsured during the Trump years. Medicaid continuous coverage has also contributed to more stable coverage in the postpartum period as my colleague Maggie Clark blogged about recently. And recent research from the Urban Institute found that Medicaid’s continuous coverage protections have reduced medical debt — especially important for people of color who shoulder more medical debt.
In conclusion, I breathed a sigh of relief that the PHE will be extended. We know COVID isn’t over and having stable health insurance is critical when facing a highly contagious and mutating virus and as cost pressures on families are rising.
Editor’s Note: CCF experts have written multiple blogs and reports sharing resources from CMS, analyzing Medicaid enrollment data, and highlighting the potential health coverage losses once the PHE ends. You can find them all here.