Last week, the Kaiser Family Foundation released an issue brief identifying areas of change and possible concerns in the Medicaid program for 2022. The brief highlights several areas to watch in 2022, including potential Medicaid changes resulting from the ongoing pandemic and Public Health Emergency, the uncertain fate of the Build Back Better Act (BBBA), various state budgets, and Biden administration efforts to further strategic coverage, access, and equity goals through regulatory action.

Notably, they identify enrollment, coverage, long-term care–in institutions and in homes and the community—access to services, and health equity as areas of interest. Noting the continuing trend of increased enrollment in Medicaid and CHIP throughout the pandemic, the report outlines several possible scenarios as some of the federal changes driving that increase expire. The BBBA would phase out some of these changes more slowly, and some states have taken advantage of increased flexibilities offered under the American Rescue Plan Act (ARPA) or those previously existing to increase eligibility and enrollment in Medicaid. Others, like South Dakota, will have Medicaid eligibility expansion on the ballot in 2022.

The report also summarizes administration actions to review and evaluate previously approved Medicaid waivers that restrict coverage or “undermine” the program, as well as some to “streamline” eligibility and enrollment processes and increase outreach to provide coverage for the approximately 7 million people who are uninsured and eligible for Medicaid.

Medicaid is the nation’s largest payer of long-term care services and, the report shows, staff and residents of long-term care facilities have been disproportionately affected by the pandemic. Both the direct impact of illness and death, and the impact of the pandemic on the long-term care workforce have highlighted the long-standing unmet need for home- and community-based services and the direct care workforce shortage. The report includes several proposed changes to federal Medicaid spending and Medicaid rules to address this need–the BBBA as currently proposed would include $150 billion in new federal funds for Medicaid Home and Community based services and update nursing facility staffing requirements to include a requirement to have at least one registered nurse on duty 24 hours a day.

The report also details the need for, and some efforts to address, improved access to care and increased attention to the social determinants of health and health equity. Post-pandemic telehealth coverage and reimbursement policies are being evaluated in most states. In KFF’s 50 state budget survey, most states reported that the pandemic prompted them to expand Medicaid programs to address social determinants of health, particularly around housing support. Both the administration and the majority of State Medicaid programs are implementing initiatives to address disparities in health care by race/ ethnicity within Medicaid. The report identifies the question of how states will leverage Medicaid to address social determinants of health and racial equity, and how the administration will support these efforts, as “what to watch” in 2022.

Read the report.