Speaker 1 00:00:18 Hi everyone. Welcome back to Just a Bite. Today I speak with my colleague, director of Health Initiatives, Zach reit on the upcoming changes to Medicaid and what Medicaid recipients will have to do during their redetermination process. Take a listen.
Speaker 2 00:00:49 Hi, Zach. Hi. And I dug into some of the snap and nutrition provisions in the Consolidated Appropriations Act in the last, um, this was the annual spending package that, um, Congress passed, um, in late December. And I wanted to talk to you about the changes to Medicaid that were included in the Omnibus for this episode. So I don't think we've talked, um, too, in depth about Medicaid on the podcast before. So could you explain how we've gotten here? What are some of, or what were Medicaid participants experiencing during the pandemic in terms of their healthcare coverage? Sure. So first, thank you so much for the opportunity to come back on the podcast and talk a little bit about the changes that are gonna be happening with Medicaid in the coming months. It's really important that people and organizations understand so that we can help people navigate these waters and make sure that they maintain access to the healthcare that they're eligible for.
Speaker 2 00:01:57 Um, to start at the very beginning, Medicaid is a program that is administered in partnership between the federal government and states. Uh, the federal government provides, um, broad oversight for the program and a lot of money for the program as well. Um, right now the federal government is paying about 70% of the total cost of the Medicaid for the state, which means, um, for every dollar that we spend on Medicaid in the state of Ohio, 70 cents comes from the federal government, and about 30 cents comes from, uh, the state of Ohio. Now, during the, um, coronavirus Pandemic Congress did something called an enhanced fmap. An FMAP stands for Federal Medical per, uh, assistance percentage. And that's basically the percentage of the, um, cost of Medicaid that the federal government pays and Congress, um, through an appropriation increased or enhanced FMAP for all states. But in order for a state to get that enhanced F map, they had to agree to what's called a maintenance of effort requirement.
Speaker 2 00:03:23 And in the case of this particular, um, act of Congress, that maintenance of effort requirement was that they would not remove anyone from the Medicaid program unless they moved out of the state of Ohio or they died. So this meant that a person who became eligible for Medicaid, maybe because their income went down or their hours were reduced, or they lost the job early in the pandemic, if they became eligible for Medicaid, applied and were enrolled in the program, they have not been removed from the program even if their income went up. Um, so to answer your question, during the pandemic, people who were on Medicaid stayed on Medicaid regardless of changes other than moving out of state or passing away. Yeah, absolutely. And I, I, um, think that is helpful considering that this was a pandemic in which, you know, folks needed that healthcare coverage, um, if or even when they got sick.
Speaker 2 00:04:38 So, um, now from my understanding, the Consolidated Appropriations Act, um, that a clear date for new renewals as well as, um, decoupled Medicaid continuous coverage from the public health emergency. Um, what do states have to begin doing over the next few months with this new clear deadline? Yeah, you brought up a really important point, which I kinda left out of my explanation, which is that this continuous coverage requirement, um, was tied to the public health emergency, and that's the federal, uh, COVID 19 public health emergency. So each time that was extended, it meant that this continuous coverage requirement was extended. Uh, like you mentioned, the Consolidated Appropriations Act changed that it decoupled the, um, continuous coverage requirement from the public health emergency and set a specific date. And that specific date is April the first of this year. Um, that means that states have, um, 12 months from that date to complete all of the renewals, um, for Medicaid. So in other words, those people who have been on the program continuously since they enrolled during the public health emergency, will now have to go through the process of being renewed to ensure that they, they're still eligible for the program. And if they're not, they'll be cycled off of that, uh, program beginning on April the first.
Speaker 2 00:06:27 Um, and I know that the federal government has given states these 12 months to kind of do that whole process. Has it, the Ohio State Legislature kind of instructed the Ohio Department of Medicaid to kind of speed up that process? And how do you think that would affect kind of this whole process as well as the impact on, um, Ohioans who are participating and receiving Medicaid coverage? Yeah, for a lot of reasons that I won't get into the Ohio legislature is anxious to get through this unwinding process. Um, and unwinding is definitely a term that you're hearing a lot. We've heard it in the nutrition world, we're hearing it in the Medicaid world. But basically we want to, um, Ohio legislators want to get through this unwinding process and remove people who are no longer eligible from the program as quickly as possible. And as you mentioned, to that end, in the last biennial budget, um, the legislature told the Department of Medicaid that they had to complete this unwinding process in just 90 days.
Speaker 2 00:07:44 Uh, meaning that they have to get through the entire caseload, which by the way, is, is up at about three and a half million people. Um, so more than a quarter of the state's population is on Medicaid. Um, the legislature said they have to get through that entire unwinding process in just 90 days, um, and also instructed the legislature to contract with a third party entity to help with that process. So they're, they're bringing in an outside organization, um, to look at Medicaid data, identify those individuals who are most likely to be ineligible for the program, and again, get through this unwinding process as quickly as possible. Now, since the legislature made that requirement of the Ohio Department of Medicaid, things changed at the federal level. Um, the Biden administration through the Federal Centers for Medicare and Medicaid Services came out and provided guidance to states that said, no, you can't renew more than one ninth of your Medicaid population each month through this, um, unwinding process.
Speaker 2 00:09:04 And they encourage states to take the full 12 to 14 months, um, as was allowed by their guidance. I'm not entirely clear on if or how the Consolidated Consolidated Appropriations Act changed that, but all indications are that the department intends to take about a year to get through this unwinding process despite the legislature's requirement to complete it in 90 days. And really, there's some advantages to that. Um, we have to remember that wildness unwinding is staring us in the faces right now. Um, we will continue to have to renew eligibility for people in Medicaid at least once every 12 months. That's a federal requirement, and it has been for a long time. Um, so if you can imagine a scenario where we did all of these renewals in the space of 90 days, that would mean that every year we come up to this place where we have a huge number of re renew renewals to today do over that 90 day period.
Speaker 2 00:10:23 And that would put a lot of stress on our technology systems and would put a lot of stress on our County Department of Job and family services, and it would really be an untenable situation. And Director Corcoran from the Ohio Department of Medicaid spelled that out throughout the entire budget debate, talked about sort of a pig and a python. If you can, um, imagine that visual, a python eats a pig and there's a big mound, um, in the middle of it. And that's what the department and county departments of Job and family Services would be facing each and every year if we did this in 90 days. So in response to that, um, federal guidance about not you doing more than one ninth of renewals in a month, all indications from the department have been that they're gonna spread this out and not create that situation where there's a major uptick in the number of renewals that need to be done, um, one quarter every single year here.
Speaker 2 00:11:25 Going forward, it seems like it's already a huge undertaking, and that expedited process would make that even a larger undertaking. Um, I know that Ohio has some other sort of major changes to Medicaid with the next generation plan that, um, require some action on behalf of the participant that they're, they're taking on all of this all at the same, same time. Um, so I wanna, I know you spelled this out a little bit, but what are some of the concerns here? Um, and then also what are some flexibilities that states have to, um, help comb through the caseload and make these re redeterminations? Right. Well, you know, Sarah, I think I'm just gonna start by saying, um, health insurance really isn't the thing that's on the top of everybody's mind unless they are sick or injured or in, in regular need of accessing healthcare. Um, so I, for me, if I get a, a letter from UnitedHealthcare or Anthem or whoever my employer-sponsored insurance provider is, I sometimes, you know, put that on the side table and maybe don't look at it for, um, quite a while.
Speaker 2 00:12:46 Um, and I think that's a reality for, again, most people who do not have healthcare, um, at the top of mind all of the time. And what the reason that's a bit of a problem in this situation is that people who have been continuously enrolled in Medicaid in some cases for almost three years now, will need to take action in order to stay enrolled. Um, people need to update their contact information with the Ohio Department of Medicaid, and they can do that online through benefits ohio.gov or by contacting their County Department of Job and Family Services. They need to read their mail from the Ohio Department of Medicaid in the Department of Job and Family Services, and they need to respond to any requests for information that we get. The main concern is that people who are still in fact, eligible for Medicaid are re are removed for what are called procedural re reasons, right.
Speaker 2 00:13:59 Or administrative reasons. They got a letter from the department asking for an income verification or an in, uh, a verification of re residency, and they didn't respond in the timeframe allowed. So they're removed from the program. That's the thing we want to avoid at any and all costs so that when a person, um, is injured or comes down, uh, be becomes sick, um, they have access to that Medicaid coverage and there's not, there's not a need to go through some sort of an emergency procedure to get 'em, um, enrolled in Medicaid. Now, the federal government has taken some action to sort of ease the burden on states and reduce the number of procedural denials that we end up with, or procedural removals from the program. And the state of Ohio has taken up some of those, what are called waiver authorities. Um, one example of those waiver authorities is the ability to update contact information based on information that managed care organizations have.
Speaker 2 00:15:17 Um, another is to use the US Postal Service to, for example, pick up forwarding addresses that people may have filed with the postal service that they did not, um, file with the Ohio Department of Medicaid. Another authority that, that the federal government has allowed is to use SNAP, um, eligibility as an indicator of Medicaid eligibility. And honestly, that's the one that I am most excited about and I think holds the most potential. Um, Jim Ashmore, who's with the Ohio Department of Job and Family Services Directors Association has said in a few meetings that I've been in recently, you know, we can go back and retroactively pay a person's medic medical bill and get them on the Medicaid program policy allows us to do that. We can't retroactively go back and feed a person. Right. SNAP benefits, I think, to consumers who are receiving them are much more top of mind, right?
Speaker 2 00:16:31 It's the money that they, they're using to go to the grocery store. Um, and so this authority allows the Ohio Department of Medicaid to look at a SNAP case and say, if a person is still enrolled in snap, they, they are eligible for Medicaid and they should stay enrolled in the Medicaid program. If the Ohio Department of Medicaid and Ohio Department of Job and Family Services can work together effectively to make sure that people who are enrolled in map in, in SNAP stay on their Medicaid coverage, I think that'll go a long way to reducing, again, those procedural, uh, removals from the program. So that's the one that, um, when I'm talking with administrators, um, at the, the Ohio Department of Medicaid, I'm really focusing on making sure that implementation of that specific authority, um, is solid throughout this process. Yeah, that's huge. Um, and I think that'll be a huge help.
Speaker 2 00:17:40 Um, there, there'll of course be some changes to folks snap ca snap cases and the amount of money that they're receiving, but at least they aren't. Um, you know, they'll start having these redeterminations. But, um, of course, like you said, it's much more top of mind, um, where they're gonna get their groceries next than, um, their healthcare coverage usually, um, given some except exceptions. So, um, I have one last question. You touched on, um, a lot here. Um, I I, Sarah, if I could, I just, yeah, I just wanna, you know, highlight that with the ending of the SNAP emergency allotments, um, people are gonna see a reduction in the amount of money that they have to purchase food, particularly in this environment where the cost of food is just skyrocketing. Um, I think, you know, people are in a difficult situation. Gas is more expensive, food is more expensive, rent's more expensive.
Speaker 2 00:18:46 Um, and everything that we can do to reduce the sort of procedural burden on a person in this environment is just so important. People need to be focused on their families. They need to be focused on what's next for them, their education, their career. Um, we don't need people worrying about whether they've submitted the verification that's necessary to stay on Medicaid. We as a system need to be taking their responsibility through this online process to ensure that people don't lose access to the supports that are really making that next step possible. So I'm so glad that you brought up the Snap emergency allotments, cuz I think it just really helps to focus us. I assume most of the just listeners are people from organizations that are doing this work and I think it just really focuses us on why administrative advocacy through this, um, process is so important.
Speaker 2 00:19:58 Yeah, absolutely. And, and we as advocates have kinda tried to advocate but also work with the administration to make things easier on families. And I think that's such an important point that, um, for a lot of folks who are on Medicaid and um, who are receiving snap their lives are stressful enough. And if they can eliminate those barriers, um, to, you know, getting the grocery money that they need or getting the healthcare coverage that they need, um, that is just so helpful for them. And I think it kind of brings a little bit of dignity and humanity into the whole process. Absolutely. Absolutely. And you talked about the work that we've done, um, with some of these agencies. You know, the Ohio Association of Food Banks is an ACA navigator. We receive money from the federal government to put boots on the ground helping connect people with marketplace coverage and Medicaid coverage.
Speaker 2 00:21:07 Um, so we are very much focused on this unwind process and one of the things we've been able to work with the Ohio Department of Medicaid on is adding some language to the termination notices that will go out to people who are no longer eligible for Medicaid that says you may be eligible for coverage through, through the health insurance marketplace and you can go to healthcare.gov to enroll, or you can reach out to one of our navigators to get help through that enrollment process. So we know that many Ohio, probably hundreds of thousands of Ohioan are going to get the news that the health insurance they've had for a few years now, they're no longer eligible for. And through that notice language and a lot of the public outreach we're doing, we're hoping that people will end up in our offices going over the marketplace coverage options that are best for them.
Speaker 2 00:22:10 Some people will be able to go on to employer provided health insurance, others may be able to go on to a parent's plan or some other, um, source of health insurance coverage. But many, it's estimated nationally that about a third of people who are removed from the Medicaid roles through this process will need to enroll in marketplace coverage and navigators are available to make sure they find a plan that fits their budget and meets all of their medical needs, um, and has providers that are available in their community. Um, so that's, that's one of the things that we've worked with the Department of Medicaid on doing. Um, so again, people don't fall into a situation where they no longer have Medicaid coverage and they can't find another source of coverage to meet their healthcare needs. Yeah, that's, that is great. Um, providing a kinda landing for those families that are, that need marketplace coverage. I think that's a great segue to my last question, which was, um, you know, how can families, um, enroll in marketplace coverage if they've lost Medicaid coverage? And, you know, how can be people get connected to those marketplace navigators, um, to help them walk through that process? Yeah, well it was a great segue, wasn't it?
Speaker 2 00:23:45 Uh, so yeah, as I mentioned, um, it's estimated that about two thirds of people who lose Medicaid coverage through the unwinding will be able to access coverage through their employer, through a parent's plan or through some other, um, source. So people will need to look out for those notices and be in touch with their employers if they know that there's a plan available. Um, be in touch with their human resources department or the person at your organization who handles that and learn if and how you can get enrolled. Um, most people who lose coverage through Medicaid will be eligible for what's called a special enrollment period in their employer provided plan or on the marketplace. And again, as I mentioned, it's estimated that about one third of people who lose coverage through this process will be eligible for coverage on the federal health insurance marketplace.
Speaker 2 00:24:48 Um, and people can enroll themselves in the federal marketplace by going to healthcare.gov. Um, or they can contact one of our navigators to get help working through the eligibility and enrollment process and they can sign up for an appointment with one of our navigators [email protected]
or by calling our hotline at 8 33 NAV for i ns or NAV for insurance. Is, is what that short for. It's 8 3 3 6 2 8 4 4 6 7. Um, and what we'll do as navigators is sit down, talk to a person about their healthcare needs, um, help them through the application process, make sure that they are able to take advantage of all of the cost savings that are available to them, the premium tax credits and the cost sharing reductions for deductibles and co-insurance and co-payments. Um, and then after we've completed that eligibility process, we'll help a person comb through all of the health insurance plans that are available in their county, um, so that they can pick a plan that again, meets their budget, um, meets their medical needs and has providers that are in that work in their community.
Speaker 2 00:26:23 So people can do the process on their own through healthcare.gov or they can reach out for help from us. We really do, um, somewhat selfishly want to encourage people, uh, to reach out for help from a navigator cuz again, that way they're just, they're not on their their own through the process. They have a person who's providing free and unbiased help finding that health insurance needs their needs process and it's have a helping hand there. Yeah. You know, that's, that's important. Again, I'm sure most of our listeners are with nonprofit organizations or government organizations and you know, I've, I've never had to select plans. It's always been selected for me cuz I've always worked at small nonprofits. Um, people who are in government maybe have two, three plans to select from in some places on the marketplace you could have over a hundred different plan options to comb through. And so having that navigator who can really help ask you the right questions and help you use the tools on the website to find the plan that's best for you is really, really important. Yeah, definitely. And in your community and, um, you have some comfort and familiarity with them. So yeah, it's a great resource. Yeah. Awesome. Well thank you so much Zach for talking with me today. I think it was a really helpful discussion for our listeners. Thank you Sarah.
Speaker 1 00:28:09 I hope you enjoyed my conversation with Zach. I wanted to end by talking about something we didn't really touch on during the interview, which is that the unwinding process will disproportionately impact families of color. As states begin this process, people could lose their Medicaid coverage, not because they're ineligible be, but because of procedural reasons. Like, for example, not receiving and or returning paperwork, not being able to wait in long lines because of other health demands and losing coverage and applying again the center on budget and policy priorities. States quote, such barriers disproportionately affect people of color who are more likely to receive coverage through Medicaid do in large part to structural inequities resulting in their overrepresentation in low paid jobs, lacking employer-sponsored health health coverage in 2021, black and Latino people made up approximately one third of the US population, but roughly half of enrollees in Medicaid and chip.
Speaker 1 00:29:21 This means that access barriers to Medicaid affect a disproportionate number of people of color, sometimes leaving people without coverage and often making this process more time consuming and difficult than necessary. End quote. So this is why spreading the word is so important because it will likely be a shock for many after not having these redeterminations for years. And this will disproportionately impact families of color to a certain extent. We also can and should ease the burden on families and help transition them off of Medicaid if necessary. As seamlessly as this process can be. Please help us spread the word. You can find information that we discussed in the show notes. Thank you for listen, and we'll talk to you next time.