June 16, 2023 – The federal Public Health Emergency (PHE) for COVID-19 expired this spring. “We are in a better place in our response than we were three years ago, and we can transition away from the emergency phase,” declared the Department of Health and Human Services in February. Among the changes expected to affect physician practices are:
- Medicaid eligibility: The Medicaid Continuous Enrollment Provision will cease, which could lead to loss of Medicaid and Children’s Health Insurance Program (CHIP) benefits for many. In addition, Emergency Allotments for the Supplemental Nutrition Assistance Program (SNAP) will stop.
- Stark Law: When the PHE ends, blanket waivers of certain provisions of the physician self-referral Stark Law will end.
Providers fear the end of the Public Health Emergency (PHE) will mean the loss of Medicaid coverage for millions of people. Through its “continuous enrollment provision,” the federal government during the PHE required state Medicaid agencies to provide coverage even if an individual’s eligibility changed. (Before the PHE, individuals could be cut from the program for failure to report a change in family status or income.) Consequently, enrollment for Medicaid and the Children’s Health Insurance Program (CHIP) increased by 20.2 million people from enrollment in February 2020, the Kaiser Family Foundation found.
Expiration of the continuous enrollment provision means that 17.4% of Medicaid and CHIP enrollees – approximately 15 million individuals – will probably lose Medicaid coverage, according to the Assistant Secretary for Planning and Evaluation of the U.S. Department of Health and Human Services. Children and young adults will be impacted disproportionately, with 5.3 million children and 4.7 million adults ages 18-34 predicted to lose Medicaid/CHIP coverage. Nearly one-third of those predicted to lose coverage are Latino (4.6 million) and 15% (2.2 million) are Black.
Certain states may be hit particularly hard. Nevada’s enrollment in Medicaid and CHIP rose 47% during the pandemic, according to Kaiser Health News. Many signed up toward the start of the pandemic, when the state’s unemployment rate spiked to nearly 30%.
Approximately 25% of Illinois citizens are enrolled in Medicaid under Illinois’ current rules, says Rodney S. Alford, M.D., president-elect of the Illinois State Medical Society. “The continuous coverage provision has provided much-needed stability to patients who rely on the program to get healthcare services and has helped ensure that physicians who accept Medicaid patients can trust that their enrollment status is current. Illinois State Medical Society members are wary of the unavoidable disruption that will be caused when the redetermination process is resumed after more than three years of continuous eligibility.”
Read more in the latest issue of Repertoire Magazine.