Unwinding the Medicaid Continuous Health Coverage Benefit
Big changes are coming to Kentuckians who qualified for uninterrupted health coverage during the pandemic. Here’s what thousands of us, and members of our communities, need to know.
Provided by the Kentucky Cabinet for Health and Family Services
Tens of thousands of Kentuckians who have benefitted from continuous health coverage during the COVID-19 pandemic are about to be faced with a decision about where to get health coverage.
In March 2020, as part of COVID-19 relief legislation, the federal government provided increased Medicaid funding to states to help with increased costs associated with testing and treating patient with COVID-19. The legislation required states to keep eligible individuals enrolled in Medicaid until the public health emergency, also referred to as the PHE, comes to an end.
The PHE, which is determined by the U.S. Department of Health and Human Services, kept about 187,000 Kentuckians from losing their Medicaid coverage. During the PHE, Medicaid was prohibited from terminating someone’s coverage unless they asked to be disenrolled, moved out of state or passed away.
Actions that were intended as help during uncertain times are expected to come to an end in the coming months and could mean changes for some individuals enrolled in Medicaid.
The U.S. Department of Health and Human Services will give states a 60-day notice, letting Kentucky and other states know when the PHE will end. It’s at this point that steps will be taken to “unwind” changes that were made to ensure individuals maintained health care coverage and begin the normal process for reviewing enrollees’ eligibility for Medicaid.
What ‘unwinding’ means
In ordinary times, trained Medicaid eligibility workers check Medicaid eligibility records to make sure the individuals in the case remain eligible. Based on federal regulations, the workers must first look to see if they can determine eligibility using information in federal and state databases, such as state wage indexes and tax returns.
If no records are found or the records do not match what an individual has reported, the Department for Medicaid Services will send renewal notices with requests for information (RFI) to enrollees.
When enrollees receive the RFI and submit the requested documentation, new cases will be processed and coverage will be renewed for those who are eligible.
Thousands of Kentuckians could lose their eligibility if they do not respond to the RFI. Their coverage will end. If enrollees don’t respond – maybe they moved and changed their address, or maybe they have a different phone number – or maybe they’re not sure what they are supposed to do – they will lose their health coverage.
The good news is, the Centers for Medicare & Medicaid Services (CMS) isn’t flipping a switch and terminating Kentuckians on, say, Aug. 1, 2022. They are giving states an unwinding period of up to 12 months to initiate renewals for all enrollees. And CMS is protecting consumers by not allowing states to take negative action based on older information the state may have obtained during the public health emergency.
What happens next?
Kentuckians should get ready now to renew.
- Make sure your contact information is up to date.
- Check your mail for a letter.
- Complete your renewal form (if you get one) by mail, uploading to a smart phone or getting help from an assister, called a kynector. (Please visit https://kynect.ky.gov for more information).
The timing of unwinding is not yet known, and Kentucky is busy planning for its arrival.
Governor Andy Beshear said, “Thousands of Kentuckians, including those who are still eligible for Medicaid, could lose coverage or become uninsured or experience gaps in coverage. We will do everything possible to make sure people who get Medicaid benefits know what to do, when to do it, or where to get help if they want help doing it.”
Cabinet for Health and Family Services Secretary Eric Friedlander said every cabinet agency, including DCBS, the Department for Medicaid Services, the Department for Public Health, the Department for Aging and Independent Living and the Department for Behavioral Health, Developmental and Intellectual Disabilities, will help spread the word about what enrollees will need to do.
“Working with Managed Care Organizations that are covering Kentuckians with Medicaid benefits; licensed health insurance agents; our assisters, known here in Kentucky ask kynectors; our community partners, including associations, health care systems and provider practices and nonprofit groups, are among the many ways we plan to let Kentuckians know they must complete a renewal. If someone is confused by the renewal form, all of us will work together to spread the word about where to get help. For the Kentuckians who will lose their eligibility for coverage, we will work hard to make sure where they can obtain coverage and how to go about doing that. And, if someone loses coverage or experiences a gap in coverage and needs help reapplying to return to Medicaid, we will assist with that,” Friedlander said.
Medicaid Commissioner Lisa Lee states, “Our focus remains on our members and ensuring individuals who are eligible for Medicaid remain enrolled in the program when the public health emergency ends.”
More information will be shared once the PHE end date is declared. Kentuckians can expect to get information in numerous ways, including TV and radio updates; print and online newspapers, magazines, blogs and press releases; from highly visible signs, including bus stops, billboards, posters and fliers; from notices sent directly to mailboxes from several sources.
More information will be shared as it becomes known.
