New York, NY—The COVID-19-related Medicaid continuous enrollment policy that has been in effect since 2020 expires on March 31. This will likely lead to significant coverage losses nationally as states begin recertifying eligibility for Medicaid and the Medicare Savings Program (MSP). Some current enrollees will no longer qualify, but those who do are also at risk; they must navigate burdensome administrative processes to stay enrolled, often with little guidance or support. Compliance may be especially difficult for some, including those the state cannot reach because they moved or changed their contact details. Others may be unaware they need to make a coverage decision or provide updated information, or they may have trouble submitting the necessary documents.
In early pandemic-response legislation and subsequent rulemaking, Congress and the Centers for Medicare & Medicaid Services (CMS) incentivized states to maintain then-current Medicaid and MSP enrollment throughout the public health emergency (PHE). December 2022 legislation delinked this policy from the PHE, and it is now set to end this month.
While these protections have been important to ensuring continuity of care during the pandemic, as they expire, older adults and people with disabilities could experience significant coverage gaps and barriers.
“At Medicare Rights, we support and applaud the steps CMS and New York State are taking to make coverage recertifications and transitions as painless as possible,” said Fred Riccardi, president of the Medicare Rights Center, a national, nonprofit consumer service organization that works to ensure access to affordable health care for older adults and people with disabilities. “We encourage a close look at measures that will enable older adults and people with disabilities to gain Medicare coverage seamlessly and stay enrolled in Medicaid.”
In Spring 2023, New York will begin notifying consumers about these changes. All current Medicaid and MSP enrollees will receive important paperwork that they must complete and return by the stated due date to maintain coverage.
The eligibility redeterminations in New York will begin soon. Medicaid and MSP cases with a June 30, 2023, end date will be closed effective July 1, 2023, if consumers do not recertify by completing the necessary renewal forms. Cases will continue to be renewed monthly, and New York must complete the unwinding process of eligibility redeterminations by the end of May 2024.
“It is important for consumers to check their health coverage and see what might change in the coming months,” said Mr. Riccardi. “If someone has Medicaid, they should contact their state agency to see what they need to do to recertify. Importantly, if they find out they no longer qualify, they might still be eligible for a Medicare Savings Program to help cover their Medicare costs. Those who still need to sign up for Medicare can use the new Beneficiary Enrollment Notification and Eligibility Simplification (BENES) Act Special Enrollment Period (SEP) to do so without penalty, and there is also an SEP for marketplace coverage for people losing Medicaid.”
Last year, the Medicare Rights Center submitted comments in response to a proposed rule that would ease enrollment into and retention of Medicaid, MSPs, and related programs like the Children’s Health Insurance Program (CHIP). The rule would bring state and federal processes more in line and would reduce churn—enrollees losing eligibility because of procedures that create obstacles to staying enrolled. These changes are needed due to the looming end of the Medicaid continuous enrollment requirement.
People with Medicare who have questions can call Medicare Rights’ free helpline at 800-333-4114.