Several panelists discussed Medicaid redeterminations and the future of the program at the 2023 Maryland State of Reform Health Policy Conference. Maryland has already begun the redetermination process due to the end of the federal public health emergency (PHE), which allowed for continuous Medicaid coverage during the first few years of the COVID-19 pandemic.
Alyssa Brown, director of innovation, research and development at the Office of Health Care Financing, provided insight on how the state has been addressing redeterminations.
“Maryland has continued to do redeterminations, actually, throughout the COVID period. Some states paused that entirely—they stopped taking any action with respect to enrollment. Maryland wasn’t one of them. We did continue to do redeterminations that whole time, but the one difference being we extended coverage for any individuals who weren’t found eligible for coverage, or who just failed to come back in and apply.”
— Alyssa Brown, director of innovation, research and development, Office of Health Care Financing
Brown said she believes this puts Maryland at an advantage in comparison to other states that conducted a full-stop of redeterminations. The state saw a substantial increase in enrollees during the PHE. It had 1.4 million in February 2020, and 1.8 million by the end of May.
During the first six months of disenrollments, which Maryland began last month, the state will prioritize certain populations, such as those who are currently ineligible for Medicaid due to life changes, including those who turned 65 during the PHE, or those who reported an increase in income. While these groups will be prioritized, Maryland plans to spread redeterminations out over a 12-month period.
Brown said individuals who are disenrolled will have a reconsideration period so they can reapply within 120 days of losing coverage. If they are found to be Medicaid eligible, their coverage will be reinstated, and they will become re-enrolled within the same managed care organization within 10 days.
Kathlyn Wee, CEO of UnitedHealthcare Community Plan of Maryland and the District of Columbia, described how individual plans are communicating with members through every channel possible, including social media and direct outreach.
At a separate panel discussion on the future of Medicaid, Ryan Moran, deputy secretary of the Maryland Department of Health, said the first and foremost goal during the redeterminations process is to ensure that everyone who is eligible remains enrolled. Maryland has linked the Supplemental Nutrition Assistance Program (SNAP) with Medicaid, so if individuals sign up for SNAP and qualify for Medicaid, they can become enrolled easily.
Moran estimates that there are about 10,000 people who are ineligible for Medicaid, and that the unwinding period will require an all-hands-on-deck approach. To close coverage gaps, the state is launching continuous coverage for children.
“We know that there’s a ton more efforts to do to ensure we reach more individuals,” Moran said.
Looking towards the future, Moran said the state will continue evaluating opportunities, such as allowing for incarcerated individuals to receive Medicaid coverage prior to their release from the carceral setting. California was the first state in the nation to ensure healthcare to this population.
Other areas of opportunity include trying to get undocumented individuals on Medicaid. Cynthia Woodcock, executive director of the Hilltop Institute—a nonpartisan research organization at the University of Maryland—said the institute is running data for undocumented individuals, trying to determine how many there are, and how much it would cost to get those individuals covered.
“Recent guidance came from (the Centers for Medicare & Medicaid Services) about an expansion of school-based health,” said Moran, adding that the state is actively reviewing guidance with hopes of creating a coordinated healthcare system within school systems throughout the state.
Hilltop Institute has created a new interactive system for redeterminations. A public edition will be published on its website, and it will include dashboards with redeterminations data that will be updated on a regular basis.
“We have a relatively new decision support system—we call it Data Port—and there’s an extensive private edition for the Department of Health.”
— Cynthia Woodcock, executive director, Hilltop Institute