Approximately 1.68 million Marylanders—over a third of the state population—are Medicaid recipients as of Feb. 18. Beneficiaries are currently protected from being disenrolled during the federal public health emergency (PHE), which is expected to extend into July 2022. However, once the PHE ends, enrollees who lost eligibility may lose their coverage.
In this Q&A, Deputy Medicaid Director Tricia Roddy and Office of Eligibility Executive Director Debra Ruppert discuss the steps the Medical Assistance Program (Medicaid) has taken to prepare for potential disenrollments.
State of Reform: What impacts are you most concerned the end of the PHE will have on Maryland’s Medicaid population? What steps have you taken to prepare for potential disenrollments?
Tricia Roddy: “Maryland is a bit unique from other states because we have been doing [redeterminations of eligibility] going back to March 2020. We’ve been keeping up with redeterminations as much as we can.
However, one concern we have is that there are some folks who have never had to go through a redetermination process. They may have forgotten what it means to be redetermined in the Medicaid program and might need a little more assistance or communication to make sure that they’re [updating] their information.”
SOR: What is your current process for redetermining eligibility?
Debra Ruppert: “In Maryland, we have the ex parte process in place for our [Modified Adjusted Gross Income (MAGI)] recipients. An average of 50% of recipients per month go through the auto-renewal process. As Trisha mentioned, we have continued to do redeterminations all through the PHE, which has kept us very connected with our individuals. In addition to that, CMS shared some operational suggestions, partner [managed care organizations (MCOs)], etc.
We have had this in place for more than 10 years, where we share files with our MCOs for recipients who need to do renewals. MCOs also do outreach through their community efforts to get individuals to come back. We have contracts with 24 of our local health departments and they do outreach. We have very many hands on the ground, and that’s why we had such a small number that we have had to extend [eligibility].
We do flag accounts in the Maryland Health Connection for those individuals that we fail to get mail returns for and we share that information too with our MCOs. I know CMS had proposed that possibly states could take the address from the MCOs. We did an outreach series seven years ago with our MCOs and our providers, advising them that if someone comes in to report a change to them, to immediately have them go to the Maryland Health Connection so that they can stay connected. That way we know that we’re getting the most up-to-date information. In the Maryland Health Connection, there’s no question about the timing of when the address changed. We’ve had that in place for many, many years, which is consistent to help us towards our success.”
SOR: Are there plans to change that process as the end of the PHE draws near?
DR: “When Medicare has an open enrollment period or qualified health plans have an open enrollment period, one of the things that we’ve asked CMS is if there is a way that once the unwinding begins, perhaps that they could do some public service announcements that renewals will begin in Medicaid again. Very broad and not state-specific, but just some communication. Possibly we could have PSAs that we could play in providers’ offices, call center lines—anything that can help get that communication out.”
SOR: Last week, several national organizations including the National Association of Medicaid Directors sent a letter to congressional leaders requesting to send notifications to state agencies of the end of the PHE at least 120 days in advance, rather than 60 days. Do you think that is a sufficient amount of time for Maryland to prepare for any disenrollments?
DR: “I support it in either way. I know that many states have programming needs that require more than 60 days to get into the pipeline for programming. Here in Maryland, we’re in a different position, but I don’t think I have any reason not to support the needs of other states. I don’t think [an extension] will have a huge impact on us.”
TR: “I think Maryland can adjust if we had a 60-day notice timeframe. Other states, because of their system, they need a bit more time to make those adjustments. At a minimum we need 60 days, but four months’ notice isn’t necessary.”
Marylanders who become ineligible for Medicaid can enroll for coverage through the Maryland Health Connection (MHC), the state-based marketplace. Open enrollment for commercial health plans through MHC is currently ongoing until Feb. 28, 2022. Assistance from a navigator or broker is available on the MHC site or at 855-642-8572.
This interview was edited for clarity and length.