On November 17th, the HPN team hosted a webinar as a companion piece to an October 2022 white paper – The End of the COVID-19 Public Health Emergency & the Effect on Health Insurance Coverage – White Paper . The HPN team included policy and operational subject matter experts who provided background on the impact the end to the Public Health Emergency (PHE) will have on both private and public insurance, as well as best practices and examples from current work within states in advance of the official unwinding period.
The nationwide PHE related to the COVID-19 pandemic – which has been in place since January 27, 2020 – will remain in effect into the winter, giving states more time to plan for the unwind. The PHE has been renewed every 90 days to maintain Medicaid continuous coverage requirements and certain health care flexibilities. It was most recently renewed on October 13, 2022. All eyes were on the US Department of Health and Human Services (HHS) last Friday (November 11th) to see if it would issue the promised 60-day notice prior to ending the PHE. Given that the notice was not provided, HHS is expected to extend the PHE when it is set to expire on January 11, 2023.
Though they have more time, states must plan now for the largest single effort to determine Medicaid eligibility in the history of the program when the PHE ends. The impact on both the commercial and public insurance markets will be profound, and states continue to innovate and enact policies to ensure continuity of coverage for enrollees ahead of redetermination efforts. There are steps states can take to ease the coverage loss and its various impacts following the end of the PHE. One option is to expand Medicaid with primarily federal funding (and, under the American Rescue Plan of 2021 (ARPA), expanded federal funding). Doing so could make significant headway in addressing coverage losses in the remaining “holdout” states.
South Dakota is doing just that. On November 8th, South Dakota became the 39th state to approve Medicaid expansion, after 56% of voters supported the measure as shown by state election data. The now voter-approved Amendment D “will direct the state to expand Medicaid next year to any person aged 18 to 65 with an income up to 133% of the federal poverty level — about $19,000/year for an individual or $39,000/year for a family of four”. The Department of Social Services estimates that 52,000 newly eligible residents aged 18 through 64 could enroll Medicaid.
There was a great effort undertaken to get Amendment D in front of voters this November, including signature campaigns to get the initiative on the ballot by organizations such as South Dakotans Decide Healthcare, The Fairness Project, and Great Plains Tribal Chairmen’s Association who took on the effort of collecting signatures for verification. These signatures were approved by the Secretary of State in mid-June and awaited election day. Opposition was met by attempted changes to voter threshold and state legislators including the Governor. Amendment D was successful in the end, after an additional Medicaid expansion Initiated Measure 28 was withdrawn from the ballot initiative process to refocus efforts solely on Amendment D.
Voter-approved initiatives can typically take effect the week after the election as soon as the vote was officially canvassed. But with the dramatic increase in enrollment, implementation may not be easy. State administrators could face additional complications depending on the state of the Public Health Emergency issued by the federal government. These changes could leave some South Dakotans temporarily uninsured even after they become eligible for Medicaid coverage.
This is just one example of options available to states outlined in the webinar. If you missed the webinar, we have made the slides available here- PHE Unwind Policy Webinar 11.17 – and are happy to assist with any questions you or your state may have related to coverage continuity or the public health emergency unwinding. Please feel free to send any questions you may have to healthpolicynews@pcgus.com.
