How to prevent millions from losing Medicaid coverage

Health-care coverage for millions of Americans is barreling toward a cliff. When the COVID-19 pandemic upended our lives and the economy, millions of Americans lost their jobs and their health insurance. Fortunately, Medicaid — which makes health care accessible for low-income individuals and families and those with disabilities — provided the coverage they needed to avoid catastrophe. Today, approximately 3.5 million Pennsylvanians rely on Medicaid, over 1.5 million of whom are children.

Unlike Medicare coverage for seniors 65 and older, in which participants remain eligible once they enroll, Medicaid has a periodic reenrollment process. During the pandemic in 2020, Congress passed a bill to ensure continuous coverage under Medicaid until the end of the federal public health emergency.

Congress has now determined that this continuous coverage protection will end on April 1. People on Medicaid will once again have to renew their coverage annually or face losing their health care. While the worst risks of COVID may be behind us, leaving patients without access to primary care, screenings, mental health care, and prescription medications would be a tragic, dangerous outcome.

We have an obligation to avert this preventable crisis. Pennsylvania, like many states that expanded Medicaid, has made tremendous strides in providing access to potentially lifesaving health insurance coverage. If we don’t act quickly to maintain continuity of care, children and young adults will be impacted disproportionately. People of color will also be harmed — nearly one-third of those predicted to lose coverage are Latino, and 15% are Black.

The loss of Medicaid coverage will also have a significant impact on hospitals and other health-care providers. Medicaid is a federal program, but it’s managed by the states, which provide hospitals and health-care providers with reimbursement for care to Medicaid beneficiaries. The program historically reimburses at a lower level than commercial health insurance companies and Medicare, which is federally funded. The gap has already created strain on the health-care system, particularly on smaller urban and rural hospitals, which are reliant on this reimbursement to stay open.

More than half of U.S. hospitals expect to lose money this year, according to a report prepared for the American Hospital Association, and the Center for Healthcare Quality and Payment Reform estimates that about 30% of Pennsylvania’s rural hospitals are at risk of closing.

The loss of Medicaid reimbursement and the pressures of providing care for uninsured patients will exacerbate these financial challenges, put more hospitals at risk of closure, and further limit access for underserved communities.

During this transition, an estimated 6.8 million Americans will lose Medicaid coverage despite still being eligible, a fate known as “administrative churn,” which happens when patients have difficulty navigating the renewal process, states are unable to contact enrollees due to change of address, or other administrative hurdles.

We must prevent these patients from falling through the cracks. One potential solution is the use of proven tactics such as “nudges” to encourage Pennsylvanians through the renewal process or the transition to insurance through the Affordable Care Act marketplace. Nudges make it easy for patients, proactively bringing them information. This could include text messages, phone calls, and door-to-door canvassing to provide easy resources directly to patients.

The federal government is also allowing states to seek waivers to enable a more efficient renewal process. Pennsylvania has already been approved to partner with managed care organizations to update beneficiary information. But there are still more tools to employ, such as using data from other state health-care programs with similar criteria to verify eligibility for Medicaid.

Targeted strategies could also support individuals in transitioning to the Affordable Care Act marketplace. We can take a page from the low-tech targeted outreach and education efforts that provided lifesaving care during the pandemic, when health-care providers brought COVID testing and vaccinations to patients right in their own neighborhoods, at locations such as churches, schools, and recreation centers.

Health-care organizations, the government, and nonprofits must work together during this process to do right by Pennsylvanians. A multifaceted approach and a tool kit of fresh strategies can minimize the impact of this transition and ensure equal access to health care for all.

Kevin B. Mahoney is CEO of the University of Pennsylvania Health System. Madeline Bell is president and CEO of Children’s Hospital of Philadelphia.

Editor’s note: The original headline of this op-ed misstated the number of Medicaid recipients who were at risk of losing coverage.