With the federal public health emergency (PHE) slated to expire at the end of 2021, millions of Medicaid patients across the U.S. are at risk of losing their coverage. Texas physicians should prepare by scheduling services as soon as possible for such patients and evaluating the financial impact of potential increases in uncompensated care. They also should expect to reverify patients’ Medicaid eligibility when the PHE expires.
The federal Families First Coronavirus Response Act increased federal Medicaid matching dollars by 6.2% for states that agree to maintain Medicaid coverage for anyone enrolled in the program from March 20, 2020, through the end of the PHE, which include Texas. Physicians can reverify patients’ eligibility electronically through the Texas Medicaid & Healthcare Partnership (TMHP) Electronic Data Interchange, TexMedConnect, or the Medicaid Client Portal. They can also call the TMHP Automated Inquiry System at (800) 925-9126.
“Through the public health emergency, [patients] have not had to jump through as many hoops to maintain Medicaid … which is wonderful and huge for public health,” said Emily Briggs, MD, a family physician in New Braunfels. “With the public health emergency ending, they will now have to start jumping through hoops that they didn’t necessarily need to, and those hoops will make it … so that people who need that access to care will potentially lose that access to care.”
The Urban Institute, a Washington think tank that frequently estimates the effects of health care policy changes, estimates the number of Medicaid enrollees could drop by about 15 million in 2022, including 5.9 million children, as a result of the PHE ending, according to a new report published in September. In Texas, Medicaid and Children’s Health Insurance Program enrollment increased by 18.1% between February 2020 and April 2021, or more than 761,000 Texans, according to an analysis by the Kaiser Family Foundation.
TMA staff say postpartum women have been one of the main beneficiaries of continuous Medicaid enrollment during the PHE. Other populations, including children, also have benefited.
Most people at risk of losing Medicaid coverage when the PHE ends will not have a coverage option because Texas has not extended health care coverage to low-income working adults and parents as allowed by the Affordable Care Act. Although temporary federal marketplace subsidies for people earning above the federal poverty level will help, many Texans likely will become uninsured because they earn too little to qualify for marketplace coverage but too much for Medicaid, according to TMA staff.
Dr. Briggs already is seeing increased demand from Medicaid patients looking to fit in wellness visits, Pap smears, routine blood work, and other procedures before the end of the year in case the PHE is not extended.
“My [patients’] parents and my patients on Medicaid are my hard-working patients,” she said. “They have jobs that don’t allow them time off unless they want to lose their job, and so they really have to plan for these things ahead of time.”
Physicians may find it challenging to accommodate these requests as patients catch up on appointments and procedures they put off earlier in the pandemic. Some practices and hospital systems may turn down patients without coverage out of financial necessity.
“Throw on top of that the potential of losing your coverage, and we have even more desperation in the system,” Dr. Briggs said.