Unwinding of Continuous Medicaid Coverage – What Community Health Centers Can Do To Prepare

Continuous Medicaid coverage has been the norm since 2020 with the passage of the Families First Coronavirus Act, and has been linked to the COVID-19 Public Health Emergency. However, the most recent spending package passed by Congress calls for the end of continuous Medicaid coverage as of March 31, 2023. The term “Medicaid unwinding” describes the process by which millions of households will be redetermined for Medicaid eligibility over a 12 to 14 month period. It has been estimated that 1 in 6 children could lose Medicaid as a result of unwinding, and 2.1 million health center patients are at risk of losing coverage. The impact on the health outcomes of community health center patients and health center revenue could be profound. The loss of revenue may not be felt immediately, but it will come as terminations begin to mount, month over month, and patients are possibly forced to transition to Sliding Fee Scale programs as their primary source to cover the cost of care. This, of course, would be detrimental both to patients and health center finances.

Community health centers can take these steps to mitigate a damaging loss of revenue and the negative impact to patient care:

Data Analysis: Health centers are encouraged to analyze their current Medicaid patient data to understand and estimate the potential loss of revenue, if retention efforts are kept the same as pre-pandemic levels. Although great effort will be made by managed care health plans, state Medicaid offices, and providers to reach members with messaging on how to retain coverage, experience shows there will be great demand for in-person assistance. This analysis will also help health centers determine whether staffing levels are adequate to help patients retain Medicaid coverage.

Clear and Simple Messaging: Messaging that provides clear direction for Medicaid patients on how to respond to the receipt of state redetermination notices, termination notices, and other communication will help patients retain coverage or transition to other health insurance options.

Organizational Education: Implement an organization-wide awareness campaign that educates all health center employees about Medicaid unwinding and the impact to the organization and patients. This prepares all health center employees to engage Medicaid members about unwinding and how to retain coverage.

Shore Up Your Enrollment Teams: Enrollment staff who help patients obtain and retain Medicaid and other health insurance coverage are indispensable to the health outcomes of patients and the financial stability of health centers. The adequate staffing level and training of these positions will ensure that all patients have access to in-person and virtual assistance in order to retain coverage during unwinding.

Medicaid unwinding has been described as the greatest disruption to coverage in the history of the program. Although the impact of unwinding might not be fully felt in the next few months, now is the time to plan strategically.

Resource:  Report by Geiger Gibson/RHCN Community Health Foundation Research Collaborative