Prepping for the end of the public health emergency: What it means for Medicaid

Typically, states have experience in natural disasters or emergency that are temporary. The current pandemic public health emergency (PHE) is extraordinary for its scale, scope and longevity. To respond to the pandemic, states were empowered with enhanced funding, programmatic flexibility and expanded coverage options for Medicaid. This means that while Medicaid was literally a lifesaver for millions of Americans impacted by the pandemic, enrollment grew by 14 percent from about 71 million to roughly 82 million, the largest single increase in the program’s history. When and how program flexibility is ended with the public health emergency could have a huge impact on those 82 million people and each and every state and territorial Medicaid department.  So how to departments prepare? And how do they ensure that those served by the program aren’t harmed? Panelists at NAMD’s Fall Conference offered these 30,000 foot take aways.

The two keys to success

• The process will be uncertain and accepting that upfront to design a response process that is nimble and flexible will be critical across each state Medicaid program.
• Transparency is critical when dealing with both Medicaid members and key stakeholders. Communicate only what is known and work to build financial predictions on available data.

Three critical areas

1. Regulatory – A smooth unwinding from the public health emergency is in the shared best interest of Medicaid, providers, plans and beneficiaries. Critical factors in building a system for a smooth transition are locating beneficiaries ahead of the need to communicate specific information and action items with them and addressing eligibility workforce capacity and training so that Medicaid departments can conduct the millions of redeterminations necessary in an accurate way.
2. Financial – Get ready to work with your actuary a lot more. Aspire to a consistent financial pulse with constant refresh of the forecast. Leverage all sources of data to be able to project rate setting, understand risk profile and durational analysis.

3. Communications – Communicate with transparency, consistency, and commitment to share what you know when you know it. Test messages and customize for members, providers, and external stakeholder groups.

One panelist said this of the monumental challenge the end of the public health emergency could mean for Medicaid:

“There is a lemonade opportunity here to change the way we do business to do it better,” Jim Jones, Medicaid Director of Wisconsin.