As the PHE Ends, Working to Ensure Individuals and Families Have Access to Health Care Coverage

Medicaid and the Children’s Health Insurance Program are facing the most significant coverage challenge since the passage of the Affordable Care Act 13 years ago.

The winding down of the COVID-19 public health emergency means that the states’ requirement to provide continuous coverage ends, and for the first time in nearly three years, states must resume normal eligibility redetermination for the 90 million individuals enrolled in these vital programs.

That effort is already underway in five states and expected to pick up steam over the next few months. Some estimates suggest that as many as 18 million people could lose coverage because of this redetermination process, with half of those being children.

The AHA is fully committed to ensuring all individuals and families are enrolled in health care coverage. We have been actively working with the Centers for Medicare & Medicaid Services, member hospitals and health systems, state, regional and metropolitan hospital associations, and other stakeholders to prepare for the Medicaid/CHIP redetermination process.

We continue to share resources to ensure that no one loses critical access to coverage and care. These include:

• AHA Advocacy Checklist – This toolkit contains a checklist for engaging with Medicaid managed care plans to support the renewal process, partnering with community stakeholders to reach enrollees, and advocating for state policies to automate the eligibility redetermination process by leveraging data from other state and federal resources.
• CMS Medicaid PHE Unwinding Resources – With AHA’s input, the agency has developed extensive resources for state Medicaid agencies and community stakeholders.
• Connecting to Coverage Coalition – AHA is a member of the Connecting to Coverage Coalition, which brings together more than 20 national organizations of providers, insurers, employers, and consumer and patient advocates to share information, best practices and solutions to ensure access to and enrollment in coverage for millions of individuals, including parents and children.

Many hospitals and health systems have been working with their state governments, patients and communities to help make sure individuals and families do not lose coverage. Some examples include communicating directly with Medicaid patients on actions they need to take to reapply for coverage; making information and resources available to patients online as well as during appointments; and developing education and training resources for front-line staff, including community health workers and financial counselors.

Coverage is central to achieving the goal of eliminating disparities and addressing health equity – a strategic priority for the AHA – by ensuring that individuals have access to comprehensive coverage. Studies confirm that coverage improves access to care; supports positive health outcomes, including an individual’s sense of their own health and well-being; incentivizes appropriate use of health care resources; and reduces financial strain on individuals, families and communities.

Meanwhile, more uninsured patients would put additional stress on hospitals, communities and the entire health care system. This would come at a time when hospitals and health systems already face unprecedented challenges, including historic workforce shortages, soaring costs of providing care, severe underpayment by Medicare and Medicaid, and overwhelming regulatory burdens.

The AHA will continue to work with all stakeholders to ensure that those who qualify for Medicaid/CHIP continue to receive coverage and those whose eligibility is no longer valid have affordable, accessible and comprehensive coverage options.