At the beginning of the COVID-19 pandemic, the federal government passed legislation to help families and health care providers amid an unprecedented health and economic crisis. Among the provisions, states were required to keep people who receive health insurance via Medicaid and the Children’s Health Insurance Program (CHIP) continuously enrolled in the programs in exchange for enhanced federal funding. This provision has helped cover more than 650,000 West Virginians throughout the pandemic.
In December 2022, Congress passed legislation phasing down the emergency enrollment provisions. Starting in April 2023, Medicaid will return to pre-pandemic eligibility requirements. Over the next year, the Department of Health and Human Resources (DHHR) will redetermine eligibility for all Medicaid and CHIP enrollees. Some will lose coverage because, while they were eligible when they enrolled, their group income now exceeds the threshold. Others are at risk of losing their coverage even though they are still eligible. Several other health insurance options exist for families no longer eligible. Additionally, many resources are available to ensure those who qualify to stay enrolled in Medicaid.
Here are four things you need to know about the changes to Medicaid. This blog post includes additional resources at the end to help people with Medicaid learn more and take action to stay connected to health care.
Between February 2020 and January 2023, the West Virginia Medicaid program has grown by nearly a third, providing roughly 161,000 additional West Virginians with health insurance.
Medicaid is highly responsive to economic downturns, and flexibility during the pandemic allows the program to address families’ needs even more effectively. In April 2020, West Virginia’s unemployment rate spiked to nearly 16 percent. While employment levels have since recovered, many families are still experiencing economic hardship. The US Census Bureau collects weekly data on how the pandemic impacts Americans’ lives. From February 1 to 13, 2023, the survey reported 11 percent of West Virginia households recently lost some or all of their income. Nearly half of those households include children. Uninterrupted access to health care continues to mitigate ongoing economic insecurity for many families across the Mountain State.
The Medicaid and CHIP programs will transition back to pre-pandemic requirements over the next year. Over this period, the state must reevaluate all enrollees for eligibility. While the DHHR has continued to send enrollees renewal paperwork throughout the pandemic, they have not been able to remove coverage from those who are non-responsive or above eligibility requirements. Beginning now, renewal forms sent to households will have consequences not seen in three years. Families must promptly fill out and return Medicaid and CHIP renewal forms to keep their coverage or be evaluated for other health care programs.
West Virginia officials estimate that nearly 200,000 people risk losing coverage because they have not returned their paperwork. Again, while some people will no longer qualify because their incomes are too high, national data predicts that most losses will occur among still-eligible people who face paperwork barriers. People who moved at some point during the continuous coverage provision may experience paperwork barriers or procedural denials due to DHHR no longer having the correct address to send renewal forms to. Others may lose or forget to return their forms or fill them out incorrectly. The West Virginia Center on Budget and Policy found that some enrollees experienced barriers that made it challenging to complete the process, including difficulty understanding the paperwork and lack of internet access. Ultimately, advocates and the state health agency aim to ensure that no one eligible for coverage loses their health care due to a paperwork barrier.
There are two actions that people enrolled in Medicaid or CHIP can take to stay connected to their health insurance. Everyone should take these steps–even if they think they might no longer qualify. First, ensuring their contact information is up-to-date with DHHR is essential. Several ways to update and verify this information include via the online portal, over the phone, by email, and at a local DHHR office. People can also confirm their renewal date to anticipate when their paperwork may arrive. Next, when they receive mail from DHHR, it is essential to open it immediately. If additional information is requested, respond and submit it as soon as possible. This action will prevent lapses in coverage for people who still qualify. For those no longer eligible, receiving a denial letter may help them transition to another form of health insurance more smoothly.
Three primary insurance providers can help families transition off Medicaid: CHIP, Medicare, and the ACA Marketplace. CHIP is a public health insurance program that covers children under 19. The program utilizes the same insurance networks as Medicaid but includes income-based copays and premiums for children in families that do not qualify for Medicaid.
Medicare is a federally-funded health insurance program that mainly covers people ages 65 and older. Some West Virginians turned 65 during the pandemic and are now eligible for Medicare. The program may be free for some people depending on income and which Parts they enroll in, but most costs are determined by an income-based sliding scale.
Finally, the ACA Marketplace provides insurance for people who do not receive public or employer-based health insurance, including those in workplaces with unaffordable insurance options. Like the other options, premiums are income-based to help make insurance more affordable. Over the past few years, the federal government has taken action to reduce Marketplace insurance costs. In August 2022, Congress passed legislation extending these decreased premiums on the Marketplace through 2025. The Marketplace is relatively more affordable than ever, and many West Virginians qualify for plans that cost less than $10 monthly, and some are even free.
Flexibilities implemented during the public health emergency helped make Medicaid even more responsive to the health and economic hardships that many West Virginians experience. Now, the program is returning to pre-pandemic conditions, and some West Virginians will lose coverage, either because they are over income or have yet to respond to renewal paperwork. There are steps people can take, including updating their contact information with DHHR and responding to mail immediately. People who no longer qualify can enroll in other health insurance options to stay insured. Please see the additional resources below for further information that can help people navigate these changes.
If you’re interested in learning more about upcoming Medicaid and CHIP changes, join us on March 28 at 6pm for a Facebook Live explaining what you need to know. During this time, attendees can also ask questions and access additional resources. Follow this link to learn more about this event and attend.
The WVCBP seeks to learn how the changes to Medicaid impact people in real-time. The Center will conduct surveys and interviews, go through the renewal process alongside selected individuals, and pay them for their time. Providers and health care advocates are also encouraged to share their perspectives. To participate, please follow this link, email Rhonda Rogombe at email@example.com, or text or call her at (304)-873-6222. She looks forward to hearing from you soon!