|
MEDICARE SECTION
It has come to my attention that there will be changes with MEDICAID BENEFITS you are currently receiving. Some may lose benefits. Medicaid and state funding is now going through an “unwinding or redetermination period.” According to CMS (Centers for Medicare and Medicaid) and the FFCRA provision, COVID-19 officially ended March 2023.
Contents of this article are taken in-part from the online article:
10 Things to Know About the Unwinding of the Medicaid Continuous Enrollment Provision - https://www.kff.org/medicaid/issue-brief/10-things-to-know-about-the-unwinding-of-the-medicaid-continuous-enrollment-provision/
At the start of the pandemic, Congress enacted the Families First Coronavirus Response Act (FFCRA), which included a provision that Medicaid programs keep people continuously enrolled through the end of the COVID-19 public health emergency (PHE), in exchange for enhanced federal funding.
The FFCRA provision requires states to provide continuous coverage for Medicaid enrollees in order to receive enhanced federal funding. By preventing states from disenrolling people from coverage, the continuous enrollment provision has helped to preserve coverage during the pandemic. It also increased state spending for Medicaid. The continuous enrollment provision for Medicaid/CHIP began February 2020 and ended March 2023. This requirement was issued by the Centers for Medicare and Medicaid Services (CMS) that lays out rules states must follow during the Unwinding Period, also called the Redetermination Period for Medicaid benefits.
Efforts are in place to conduct outreach, education and provide enrollment assistance can help ensure that those who remain eligible for Medicaid are able to retain coverage and those who are no longer eligible can transition to other sources of coverage.
But, as states resume disenrollments following the end of the continuous enrollment provision, millions of people could lose coverage and that could reverse recent gains in coverage. States can resume disenrollments beginning in April 2023 but must meet certain requirements to be eligible for enhanced federal funding during the unwinding. This Redetermination Period or Unwinding could last up to 12 months.
Eligible Medicaid individuals are at risk for losing coverage if they do not receive or understand notices or forms requesting additional information to verify eligibility or do not respond to requests within required timeframes.
All states indicated they had taken steps to update enrollee contact information during the past year and nearly three-quarters of states (37) were planning to follow up with enrollees before terminating coverage. As of March 13, 2023, 26 states had posted their renewal redistribution plan, which had to be submitted to CMS (Centers for Medicare and Medicaid) by February 15, 2023 for most states.
States completing renewals by checking electronic data sources to verify ongoing eligibility reduces the burden on enrollees to maintain continuous coverage. However, when states do need to follow up with enrollees to obtain additional information to confirm ongoing eligibility, they can facilitate receipt of that information by allowing enrollees to submit information by mail, in person, over the phone, and online.
CMS (Centers for Medicare and Medicaid) guidance provides a roadmap for states to streamline processes and implement other strategies to reduce the number of people who lose coverage even though they remain eligible. However, there will also be current enrollees who are determined to be no longer be eligible for Medicaid, but who may be eligible for ACA marketplace or other coverage (under the age of 65).
COVID-19 Federal Health Emergency ending soon: How will this impact you?
On May 11, 2023, the COVID-19 Federal Health Emergency will end. When the emergency declaration ends, it will mean changes to certain policies established during the pandemic (early 2020) that gave the federal government flexibility to waive or modify certain requirements in a range of areas.
Starting May 12, 2023, out-of-pocket expenses for certain COVID-19 benefits may change, depending on an individual’s health care coverage.
-
COVID-19 lab tests: The plan cost share will apply.
-
COVID-19 treatment: The plan cost share will apply.
-
COVID-19 over-the-counter (OTC) tests: Will now only be covered if the plan includes an OTC benefit.
COVID-19 vaccines, including boosters: Any pharmaceutical treatment doses (e.g. Paxlovid) purchased by the federal government are still free to all, regardless of insurance coverage. This is based on the availability of the federal supply and is not affected by the end of the public health emergency.
Here are some TERMS being used for this new provision and the definitions:
| 
