In April, 5 states began disenrolling adults and children from Medicaid after the restriction on disenrolling was lifted. More and more states are disenrolling members with potentially devastating impacts on patients and hospitals.
What happened
During the COVID-19 pandemic, the Families First Coronavirus Response Act created a continuous enrollment provision, allowing individuals to apply for Medicaid regardless of eligibility. By following the law, states were supplied with additional medical assistance funds.
The act was created to ensure that individuals still had access to medical care during an economically tumultuous time, but now that the public health emergency has officially ended, it's estimated that 15-18 million individuals will be disenrolled in Medicaid over the next several months.
41 states have begun–or finished–disenrolling members and the rest are soon to follow. These individuals will have 60 days to re-enroll in Medicaid if they are still eligible or enroll in an insurance program elsewhere.
Why it matters
According to the Center on Budget and Policy Priorities (CBPP), enrollees may face a plethora of challenges to find care again. While many will transition to other coverage, some may struggle with the process and experience a gap in coverage, or find that coverage elsewhere is unaffordable for them. And some may even be left unaware that this change has occurred, especially if they have moved or changed contact information.
On top of this, some individuals who are eligible for Medicaid may find themselves inadvertently unenrolled and will have to re-enroll, which can be a time-consuming and confusing process.
Even when individuals successfully enroll in a new policy, it could dramatically change their healthcare experience. Some may have to travel long distances to get the care they need or be forced to choose a new provider out of fewer options.
Going deeper
Outside of the direct effects of changing insurance, there are other ways patients may be affected. During the disenrollment process, states can expect a major increase in workload–but are they ready for it?
Currently, according to the CBPP, many agencies are already short-staffed. They are still reeling from high turnover rates caused by the pandemic. It's expected that there may be long waiting times and potentially missed deadlines for processing paperwork.
On top of this, with patients shifting to other hospitals or simply going without care, hospitals may see a decrease in revenue, which could impact their ability to purchase new technology or improve their facilities.
What was said
Travis Taylor, Account Executive at Paubox, is concerned for both patients and hospitals. He explains, "If patients aren't meeting the Medicaid eligibility requirements, then they essentially have no insurance." Patients who do switch to more expensive health insurance plans may be "forced into situations where they have to choose between their healthcare and other living expenses.
Ultimately, Taylor said, this backfires on practices because "they are going to be losing out on revenue from all of these hundreds, if not thousands, of patients that aren't coming to their facilities."
The issue causes a trickle-down effect, especially if some patients begin to forgo healthcare altogether, "If [hospitals] are unable to collect money from patients who are unable to seek care, it leads to lost revenue from these healthcare practices, which brings down their budgets. This makes it harder to invest in certain products and services that they would need."
Taylor advises healthcare organizations to think about how they can expand care, such as offering telehealth care, to meet patient needs.
Related: How does HIPAA apply to telehealth?
The bottom line
While many healthcare providers and states have been aware of the impending disenrollments, it is still likely to send shockwaves through hospitals and negatively affect patients.
Hospitals should do their best to help patients stay informed, especially if their new insurance won't cover certain providers or procedures. Hospitals should also do their best to make healthcare accessible, whether that's through telehealth or other means.
Related: HIPAA Compliant Email: The Definitive Guide.
Abby Grifno
