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Medicaid, along with its joint program CHIP (Children’s Health Insurance Program,) provides much-needed health insurance coverage benefits to more than 72 million Americans. It’s actually the single largest health benefits provider in the country. Add to the already substantial participation rates, the pandemic conditions, and government provisions for potential expansion, and now Medicaid is proving to be the only lifeline available to the vulnerable population.

As an insurance provider, you might be wondering what to expect with upcoming reassessments. Once the pandemic eligibility requirements expire, and as Americans experience even more changes to jobs, income, and healthcare needs, reassessments will ensue. And without that magic crystal ball, it’s hard to say just how the insurance providers will be affected. But there are a few trends to identify and ways to prepare yourself, to adapt to whatever lies ahead in terms of participation, eligibility, and healthcare needs.

1. Prepare for Eligibility Definitions to Change

While some of the extensions changed, allowing for loosened eligibility requirements, it’s probably best to prepare for additional shifts moving forward. Pandemic relief provisions will expire. States will explore other options. And the needs of the population will change.

An End to Pandemic Provisions

The Public Health Emergency (PHE) is ending, and with it, some of the critical provisions are allocated at the state and insurance provider level. States expressed concerns early on that even with a six-month window to complete all government-required reassessment and enrollment tasks; there will be a “renewal bulge” in the coming years, overwhelming many. With so many Americans enrolled now, the administrative task of managing enrollment, even with the end of pandemic-driven accommodations, could be detrimental. States should be preparing now for that wave of Medicaid reassessments.

Some Americans Will No Longer Be Eligible for Medicaid

Many Americans qualifying for Medicaid and CHIP coverage will find their footing in the coming weeks and months. And states will also find with reassessment an increase in Medicaid churn to manage. Prepare to understand these shifts off of Medicaid as a result of those Americans no longer needing the coverages they so heavily relied on during the economic shutdowns and furloughs of 2020.

People Going Back to Work

Prepare for Medicaid churn, too, as a direct reflection of Americans going back to work. While in some regions, unemployment rates continue to be high, it’s an applicant market right now. And as people seek to get back to normal, they’re also going to be getting back to work. With the increase of remote working sustainability, people have access to more job opportunities too. Household income levels will reflect these trends, leading to some becoming ineligible for Medicaid and CHIP.

2. Financial Changes Affecting Medicaid Eligibility

Things may be getting back to normal, away from pandemic shutdowns and furloughs, but financial changes at the individual level will continue to affect Medicaid eligibility. Providers and states should prepare for shifts in either direction since there will continue to be long-term financial effects on household income levels overall.

Americans Still Struggling to Make Ends Meet

Pandemic unemployment payments are expiring, meaning many households will experience significant reductions in income. Rent moratoriums have been extended to help renters, but there will still be economic hardships for many. States reassessing Medicaid eligibility (with requirements of Approximately $2,313 / month) may not see a vast churn in those falling off because of income for these reasons.

Continued Unemployment

Just because the PHE is coming to an end doesn’t mean people will still struggle to find work. Unemployment rates continue to be high in many parts of the country. And recent surges in the virus variants are threatening pockets of the U.S. with additional lockdowns. Businesses closing, enforcement of vaccination mandates and a flooded applicant market may contribute to continued record unemployment levels in the weeks and months to come. Anyone affected will still likely rely on Medicaid and CHIP coverage.

Economic Inflation

Even with the several rounds of stimulus checks, Americans still struggle, and it could be inflation. And Forbes says the country is effectively knee-deep in an economic inflation period right now. Citing the most recent CPI inflation reports, Forbes reports prices in July alone surged upwards of 5.4% year-over-year, and a 0.9% increase from June. During inflation periods, people will face higher costs of living, which can have a direct reflection of how states calculate Medicaid eligibility.

3. Health Conditions Changing

The primary purpose of Medicaid and CHIP programs is to ensure Americans have access to affordable healthcare when they need it. And the aftermath health effects of a global pandemic will likely continue to be measured for years to come. There will also be acute health conditions millions face already today.

Reassessment to Identify New Health Conditions

States have options to establish or redefine “medically needy programs” for anyone with significant health issues. It also applies to anyone whose income is too high for traditional Medicaid coverage. States reassessing Medicaid in the near future may find these programs to be instrumental in providing options to individuals and families.

Long-Term Effects of COVID-19 Still Unknown

Understanding the overall health of the U.S. citizens will likely change in the years to come. Even those who were affected by COVID-19 are experiencing post-infection conditions. There will be long-term effects associated with the disease that may impact how Medicaid eligibility health conditions are defined.

Neglected Procedures During Shutdown

During the shutdowns of 2020, medical procedures deemed non-life-threatening were delayed. Millions of Americans put off routine physicals and annual scans. Getting back to those doctor and specialist appointments now, some are facing new conditions or health issues. While this percentage of affected isn’t incredibly substantial, many states will likely see some of these cases during Medicaid reassessment efforts.

As you face another wave of Medicaid assessment, be prepared for these few scenarios. But again, it’s practically impossible to predict every trend. You do, however, have W3LL to help with everything from Medicaid reassessment efforts to administrative management of these programs. Contact us to explore how W3LL can help keep your offerings in line with the ever-changing landscape.


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