Navigating states and consumers through unwinding the Public Health Emergency
To learn more, visit maximus.com/PHE-unwinding or contact us at USServices@maximus.com.
Medicaid and CHIP enrollment increased to unprecedented levels during the COVID-19 Public Health Emergency (PHE). In June 2022, enrollment reached over 89 million, an increase of more than 26 percent over February 2020 [i], since the start of the PHE.
Most of this increase is the impact of the Families First Coronavirus Response Act (FFCRA) enacted by Congress, which increases Medicaid funding to states and, in turn, requires states to continue coverage for people enrolled on March 18, 2020, and those newly eligible during the PHE, with very few exceptions.
When the PHE ends, Medicaid and CHIP eligibility processing will resume, requiring states to recertify their entire caseload within a short timeframe. An estimated 15 million [ii] people — including low-income children, pregnant women, adults, seniors, and people with disabilities — could lose coverage during this “unwinding” period because they are no longer eligible. This includes an estimated 6.8 million [ii] individuals who are still eligible but risk “falling through the cracks” and losing vital coverage due to administrative obstacles during the renewal process.
The need for states to outreach, educate, and provide enrollment assistance will be essential to ensuring covered populations who remain eligible for Medicaid and CHIP can maintain coverage, and individuals who are no longer eligible can shift to other healthcare coverage options.
States will be facing a challenging road ahead. Preparedness for the PHE unwinding will be instrumental to smoothly navigating agencies and individuals through the redetermination process. Developing and executing strategic, operational plans while keeping an eye on customer service and program integrity will require collaboration with key stakeholders and the ability to pivot quickly once the PHE is lifted.
State agencies must be ready with highly trained staff and provide eligibility support services, enrollment broker services, consumer education, outreach services, appeals processing services, and support for state-based insurance marketplaces. Many states are contending with a staff shortage due to challenges with recruiting and retaining, not to mention work burnout. Staffing concerns and outdated legacy systems are two significant burdens ahead. Seamless redetermination services need an augmented workforce to clear backlogs and communicate with the public. States need to modernize their system technology to provide omnichannel self-service tools. Doing so will enhance the customer experience and simplify the redetermination process.
Maximus can help state governments meet their PHE unwinding challenges in a way that’s efficient, empathetic, and equitable.