DMAS prepares for post-public health emergency Medicaid disenrollment

The Department of Medical Assistance Services (DMAS) is currently preparing for the impending end of the federal public health emergency (PHE) declaration, which will instigate a lengthy eligibility redetermination process for one in five Virginians who currently benefit from Medicaid. 

 

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DMAS Director Karen Kimsey provided an update on the organization’s preparation for potential disenrollment, or “unwinding,” and its impact on the state budget to the Joint Subcommittee for Health and Human Resources Oversight earlier this month. 

Medicaid enrollment has increased significantly in the state, with 373,634 new members enrolling in Medicaid since the beginning of the State of Emergency on Mar. 12, 2020. Over 116,000 of these were children. DMAS also implemented several policy changes this year, such as extending postpartum coverage and adding dental services, that are associated with added costs to the state budget. 

Kimsey was unable to provide exact spending numbers for the next fiscal year as DMAS is still preparing to submit its 2022 Medicaid forecast on Nov. 1. However, she said increased federal funding has saved the state an average of $133 million per quarter. DMAS will also reinvest additional state general fund savings into home and community-based services (HCBS), which stem from federal American Rescue Plan (ARP) funding

However, Kimsey said the agency must pay attention to potential changes in the state’s Medicaid population.

“While the longer PHE will continue to bring [general fund] savings from enhanced FMAP, if that happens, there is a cost for us, as the Commonwealth, in terms of keeping our populations on Medicaid, as well as what time we are going to need once it ends, to actually redetermine all those individuals’ [eligibility].” 

Virginians under Medicaid are currently protected from being disenrolled due to the Families First Coronavirus Response Act. However, once the PHE ends, DMAS will need to redetermine each member’s eligibility, a lengthy process that Kimsey said can take anywhere from six to 12 months. This is in part because eligibility may be determined at a local-level, case-by-case basis. 

The Centers for Medicare and Medicaid Services (CMS) have released guidance for states as they begin the redetermination process, but did not specify exactly when the PHE will end. The most recent PHE renewal will expire on Oct. 18, and the Department of Health and Human Services (HHS) expects to renew it one more time through the end of 2021, according to Kimsey. However, that means the PHE could expire as soon as Jan. 2022. 

The disenrollment freeze prevented an exact estimate of people who would lose Medicaid eligibility, although Kimsey said over 337,000 cases (equating to over 644,000 members) in the state may need to be redetermined. This included individuals who turn 65 and may need to transfer to Medicare, pregnant people who reached the end of the postpartum coverage period, and individuals with changes in circumstances, such as increased income.

Kimsey said DMAS is currently working with several partners across the state to provide navigation resources to disenrolled members. CMS is also employing marketing campaigns to encourage people to sign up for insurance through the market exchange, as well as extending open enrollment until Jan. 15, 2022.

“That’s going to be the most important part, is the messaging that we share with individuals to help encourage them along [in applying].”

One of DMAS’s partners is the Virginia Poverty and Law Center (VPLC). In a previous conversation with State of Reform, Deepak Madala, Esq., VPLC director of the Center for Health Communities and ENROLL Virginia!, mentioned the importance of making resources more accessible for underserved communities, such as providing limited-English proficiency (LEP) individuals with resources in their native languages. 

Aside from the redetermination process, Kimsey shared other updates with subcommittee members. During the August special session, the General Assembly approved a 12.5% increase in reimbursement rates for Medicaid providers. The funding has been available since July 31, although it has yet to be transferred to providers. Kimsey said DMAS would “ideally” have funds transferred by the end of this month.

Kimsey also briefly spoke on DMAS’s Cardinal Care program, which will consolidate the agency’s managed care organizations with its fee-for-service programs in a single contract by July 1, 2022. DMAS plans to share a draft of the contract with relevant stakeholders in Spring 2022. 

A full recording of DMAS’s legislative update can be found here.