PCG Recap of the National Association of Medicaid Directors (NAMD) Conference: Connecting States and Policy Leaders to Discuss the Unwinding and Future Goals for State Medicaid Programs

In early October, the NAMD conference brought Medicaid Directors, the Center for Medicare & Medicaid Services (CMS) leadership, state policy makers and industry professionals together to learn from one another, and share lessons learned – in particular, around the end of the continuous coverage requirement and unprecedented Medicaid re-eligibility effort underway. PCG subject matter experts have included insights and perspective on the main topics of this year’s conference.  

Unwinding the Continuous Coverage Requirement  

Since Jan 2020, the Public Health Emergency (PHE) had been renewed every 90 days, however states had been planning for the end of the PHE which came in May 2023. Departments have begun the process of eligibility redetermination, in many instances a full eligibility review or the optional ex-parte review methodology. Nevertheless, a better picture of the enrollee populations in each state has emerged since the end of the PHE.  

The opening plenary of NAMD entitled “Progress, Priorities and Pivots at the Midpoint of Unwinding” included the perspective of state Medicaid Leaders- including Lisa Lee from Kentucky, Daniel Tsai- Deputy Administrator of CMS, and the impact on the community perspective from Georgia’s Executive Director of the Dept of Community Health. The number one takeaway from all panelists was ensuring information was communicated and various approaches to information dissemination were utilized to reach the Medicaid population. Communication was key to alert all current and potential enrollees that eligibility reviews were ongoing, information may be needed, and the time was now to check-in to ensure benefits continued, or alternative coverage was secured. State and policy leaders mentioned some of the creative ways to notify enrollees, including Kentucky who is using advertisements secured to state vehicles to alert individuals about Medicaid & Children’s Health insurance Program eligibility.  

Panelists alluded that states are in various stages of publicly reporting on the unwinding- some only making public the CMS required data points, and others sharing all information they have about the process. To follow along with state progress, the following trackers are continually updated with insights and data from state Medicaid departments:  

Although the end of the PHE meant more than just the end of the continuous coverage requirement, it will be some time before we understand the true impact of this unprecedented redetermination efforts on the Medicaid population. 

Supporting Individuals Leaving Jail and Prison:  Medicaid’s Changing Role in the Re-entry Process 

NAMD hosted a breakout session focusing on the evolving role of Medicaid in the issue of people leaving incarceration and returning to the community.  The panel included representatives from the California and Utah Medicaid programs who spoke of their respective initiatives under Medicaid 1115 waivers to expand eligibility coverage and connect formerly incarcerated people with services.  California was the first to receive CMS approval and more than a dozen other states have approvals pending.  To read a prior Health Policy News article on the demonstration and details on the Inmate Federal Exclusion Policy, click here.   

The discussion was led by Vikki Wachino, a previous executive at CMS, now leading the Health & Reentry Project.  Ms. Wachino led discussions about the many complexities that must be addressed when Medicaid interacts with the criminal justice agencies:  from always challenging systems issues (e.g., medical records systems, Medicaid eligibility systems) to basic issues like effective communications between public agencies, as Medicaid and justice related agencies have their own respective terminologies and frames of reference.  DeAna Hoskins of JustLeadershipUSA brought a unique and important perspective to the discussion as a formerly incarcerated person, who now leads a national organization that employs formerly incarcerated people and advocates for those impacted by the criminal justice system.  Ms. Hoskins described the perspectives and roles of often-overlooked stakeholders such as correctional officers, inmates working in prison healthcare facilities, and inmates who avoid behavioral health care out of fears about a negative impact on parole hearings. She stressed that successful implementation of these Medicaid initiatives would depend on involvement of inmates’ councils, and correctional officers’ unions. 

It was clear that waiver approval is just the first step. Implementing pre-release Medicaid coverage and coordinating post-release services will require states to form partnerships with jails and prisons, create new data systems, and build out networks of providers. It will take true collaboration and partnership to ensure the success of the re-entry programs in any state.  

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