What’s Going On
When the federal government authorized the Public Health Emergency (PHE) at the start of the COVID-19 pandemic, healthcare coverage through Medicaid was extended to millions of people. About 84 million people are covered by the program overall and that number blossomed by about 20 million people since the start of the PHE. Estimates suggest as many as 14 million people could lose that coverage.
This coverage provides preventative care, primary care, prescriptions, vision and dental services, and mental health services. The loss of this coverage could have a serious impact on Americans who are already struggling as a result of the pandemic.
Some Essential Services Provided by Medicaid
Medicaid is a joint federal and state program that provides healthcare coverage to low-income individuals and families, people with disabilities, and other vulnerable populations. Services provided by Medicaid can vary from state to state. Some of the essential services provided by Medicaid include:
Inpatient hospital care
Outpatient hospital care
Laboratory and X-ray services
Family planning services and supplies
Nursing facility services
Home health services
Early and periodic screening, diagnostic, and treatment (EPSDT) services for children under the age of 21
Rural health clinic services
Federally qualified health center (FQHC) services
Transportation to medical appointments
Mental health and substance abuse services
Prescription drug coverage
Rehabilitation services, such as physical therapy, occupational therapy, and speech therapy.
The cuts to Medicaid could put pressure on state and local governments that are already stretched to their limits. Local health systems, already overwhelmed, would be forced to absorb more uninsured patients – at a time when they’re already struggling financially.
Before the Pandemic…
Before the pandemic, a person’s health care coverage through Medicaid would depend on their income, coverage offered through an employer or resident status in a given State. When the pandemic started, the Families First Coronavirus Response Act legislation provided for ongoing enrollment allowing people to maintain Medicaid coverage throughout the entirety of the COVID-19 PHE. The American Rescue Plan signed into effect by the Biden Administration in 2021 also increased Federal funding for States that expand eligibility, making it easier and more affordable for individuals to get the health insurance coverage they need.
Changes to the Status Quo
The PHE was declared by the federal government in response to the COVID-19 pandemic. As part of this declaration, the Centers for Medicare & Medicaid Services (CMS) allowed states to temporarily suspend certain eligibility and enrollment verification requirements for Medicaid to ensure that individuals could continue to access healthcare during the pandemic. However, the federal government is planning for the PHE to expire on May 11, 2023.
As the PHE winds down, states will now start checking the eligibility of every person on Medicaid. This means that individuals who are currently enrolled in Medicaid may be asked to provide additional information to verify their eligibility. This information may include their address, income, household size, and other personal information.
According to one news report, Florida is planning to start removing ineligible Medicaid recipients as early as April. Other states that have reported plans to start looking at eligibility in April include Arizona, Arkansas, Idaho, Iowa, New Hampshire, Ohio, Oklahoma, and West Virginia.
It’s important to note that the specific eligibility verification requirements may vary by state. Additionally, individuals who are found to be ineligible for Medicaid may have the opportunity to appeal the decision and provide additional information to prove their eligibility. Overall, the goal of these eligibility checks is to ensure that Medicaid resources are being used appropriately and that individuals who truly qualify for Medicaid can continue to receive healthcare coverage.
Impact of Changes
The changes to Medicaid eligibility could leave millions of Americans without health coverage in the coming months. People who are already struggling to make ends meet may face new financial burdens or have limited access to necessary medical care. It is also likely that some individuals will fall through the cracks, becoming ineligible for Medicaid while not meeting the qualifications for other public programs or employer-sponsored plans. The people who will be most affected are those that live in the states that are making the greatest cuts to their Medicaid programs.
It is important for people to understand how these changes could affect them so they can make sure they have access to care when needed. Additionally, it is essential for state and federal governments to ensure that all individuals have access to the care they need, regardless of their eligibility for Medicaid.
What Should I Do Now?
Make sure you update your contact information, including your home address, phone number, and email
Look for a renewal form from your state
You should have at least 30 days to fill out the renewal form
If you don’t fill out the form, you may automatically lose your Medicaid coverage
I’m Losing my Medicaid Coverage, What are my Options?
The marketplace for the Affordable Care Act coverage has many low-cost plans available. The primary drawback, however, is that these plans while possibly inexpensive month-to-month, have high out-of-pocket expenses and copays. Additionally, while you’ve been seeing the same doctors for the past two years, your new coverage may not be accepted by your current physician forcing you to find a new physician. For people unrolled from Medicaid, a special enrollment people will be available from March 31st, 2023 until July 31, 2024. You should have up to 60 days to enroll after losing coverage.
Private Marketplace Options
Other options available to those losing Medicaid coverage include the healthcare providers in the private marketplace offering low-cost alternatives. At Vivagen Health, our mission is to make healthcare both affordable and accessible. It is widely known that securing an appointment with a primary care physician for a regular checkup can take months and a sick visit from days to weeks. An urgent care or an ER visit could result in a 1-2 hour wait. But, how do you know when to go to an ER versus an Urgent Care? The cost differences are often significant and often riddled with surprise bills.
10 Tips if You’re Losing your Health Care Coverage
Losing health insurance can be a stressful and overwhelming experience, but it’s essential to remember that you have options. Here are ten tips to help you navigate this challenging situation:
Don’t panic: Losing your health insurance can be scary, but it’s essential to stay calm and focused to make the best decisions for your situation.
Check if you qualify for special enrollment: Losing your job or health insurance coverage is a qualifying life event that allows you to enroll in a new plan outside of the usual enrollment period.
Consider COBRA coverage: COBRA allows you to continue your current health insurance coverage for a limited time after losing your job or coverage.
Look for a short-term plan: Short-term health insurance plans can provide temporary coverage while you look for a more permanent solution.
Explore marketplace plans: You can purchase healthcare plans through the Health Insurance Marketplace, which offers a variety of plans with different coverage options and costs.
Check if you qualify for subsidies: Depending on your income, you may qualify for subsidies that can help offset the cost of your healthcare plan.
Consider health-sharing ministries: Health-sharing ministries are faith-based organizations that provide healthcare cost-sharing options for members.
Look into community health clinics: Community health clinics offer low-cost or free healthcare services to people who are uninsured or underinsured.
Don’t skip preventive care: Even if you don’t have health insurance, it’s essential to continue with regular checkups and preventive care. Many community health clinics offer these services at low or no cost.
Check out low-cost options available in the private marketplace. While not true insurance, if you require hospitalization or an Emergency Room visit, they can provide access to primary care physicians and urgent care needs. This access will allow you to maintain preventative medicine services to help you stay healthy in the long term and access urgent medical care in your time of need.
At Vivagen Health, we offer primary care and urgent care visits starting at a flat low cost of $59. We can see patients frequently on the same day and if additional procedures are recommended, we will discuss the costs up-front with you and help you determine what is best for you.
Another great option is telemedicine appointments at Vivagen Health, which start at just $29. Vivagen Health can be your medical home, offering affordable and timely appointments for primary care, urgent care, and even telemedicine while you’re on the go (Florida-based patients only).