The Biden administration plans to lean heavily on the Affordable Care Act’s insurance exchanges to sign up people who may quickly drop off Medicaid’s rolls once the public health emergency ends, according to the head of Medicare and Medicaid.
Centers for Medicare & Medicaid Services Administrator Chiquita Brooks-LaSure said that the agency realizes states have a pending dilemma with how to redetermine Medicaid eligibility after the end of the COVID-19 public health emergency ends, which could be some time next year. The emergency prevented states from dropping Medicaid beneficiaries from the program.
Brooks-LaSure spoke of the issue on Friday during the Medicaid Health Plans of America conference in Washington. The group represents the Medicaid managed care industry.
“We do understand the pressures that states are under,” she said during a virtual speech.
The agency also has concerns about how to maintain coverage levels for individuals who may lose Medicaid eligibility because they earn too much. CMS gave states a year after the emergency ends to restore normal income eligibility requirements.
Brooks-LaSure said that ACA marketplace coverage is going to play a key part in keeping people covered after the emergency ends.
“We are very focused on integrating as closely as we can Medicaid and marketplace coverage,” she said. “We actually have a unique opportunity to … streamline enrollment because of the American Rescue Plan.”
The administrator was referring to enhanced income-based subsidies passed under the law earlier this year and expire after the 2022 coverage year. Democrats in Congress are working to extend the subsidies past that date as part of a $3.5 trillion infrastructure package.
“We have people right about the Medicaid level who have much higher subsidies than they do normally,” she said.
CMS has also made moves to ensures signups on the marketplace are easier, including extending by 30 days the 2022 open enrollment period that starts in November.
There are also special enrollment periods for people to sign up if they lose coverage, Brooks-LaSure added.
“That is one way we can continue to ensure that people move into care if they are losing eligibility because of income,” she said.
The end of the public health emergency could affect coverage for millions of people, a recent study said.
The study conducted by the Urban Institute found that 15 million people could be dropped off the Medicaid rolls after the emergency ends. States will need to inform enrollees of other coverage options such as the ACA marketplace, researchers said.
Aligning care for duals
Brooks-LaSure also spoke about the need to improve integrated care between Medicare and Medicaid for dual-eligible beneficiaries.
“They are currently an underserved population,” she said.
CMS did create dual-eligible special needs plans which are Medicare Advantage plans available to duals.
However, about 3 million dual-eligible beneficiaries are enrolled in such plans out of roughly 10 million dual eligibles.
“As we all know Medicare and Medicaid have different payment incentives and so it is so important to make sure that care is integrated,” Brooks-LaSure said. “One of the things we are also looking at is these times where people are enrolled in different managed care programs … and can we align there.”