The Centers for Medicare and Medicaid Services (CMS) is preparing for a major shift in services and is using tools like telehealth and health insurance marketplace to support the transition.
More than 100 million people rely on CMS for health care coverage, and since the pandemic that number has grown expeditiously. During the peak of the pandemic, Congress launched the Families First Coronavirus Response Act (FCCRA), which established a protocol that required Medicaid programs to keep people continuously enrolled until the COVID-19 public health emergency (PHE) ends.
Now that the emergency declaration is set to end at the end of the month, the FCCRA will follow suit, meaning more than 90 million people who were receiving coverage under the continuous enrollment provision may lose it.
For CMS this process is known as “unwinding,” which will involve a transition back to the original Medicaid eligibility operations.
“As of November 2022, over 91 million people were enrolled in Medicaid and the Children’s Health Insurance Program (CHIP). State Medicaid agencies will redetermine eligibility for Medicaid or CHIP for all of these people between now and May 31, 2024,” a CMS spokesperson said.
As the Medicare eligibility comes to an end for some, CMS is implementing a multi-pronged public outreach strategy to inform patients of the health care changes.
“This includes national and local public engagement, paid advertising, media engagement, communications toolkits and materials, and direct-to-consumer communications,” CMS spokesperson said.
During the massive shift, CMS will rely heavily on technology to ensure a smooth transition.
As they work to make sure health care remains available, CMS has revamped its Champions for Coverage program, which includes an online health insurance marketplace for uninsured Americans. Following the upgrade, the program has quadrupled the number of navigators who are on standby to help patients enroll online.
CMS allocated a total of $100 million to federal "Marketplace Navigator" grantee organizations for the 2022-2023 budget period, including $12.5 million in support of additional direct outreach, education and enrollment activities for unwinding
“Navigators and other assistance personnel will maintain a critical physical and virtual presence in communities across the U.S. to help consumers understand basic concepts and rights related to health coverage, provide enrollment assistance and work with individuals to link coverage to care,” the CMS spokesperson said.
Now, as CMS continues to dedicate resources to technology, the agency plans to keep its user experience high while undertaking a shift in accessibility.
“CMS is committed to using every tool at our disposal, including the latest technological advances, to improve the health care experience, solve the health care issues impacting people’s lives, and drive toward an equitable and person-centered health care system,” the spokesperson said.
CMS’ recent efforts are backing cross-government priorities to improve the digital experience for citizens — a 2021 presidential executive order. This includes ensuring patients living in undeserved and rural communities still receive access to care. This is where telehealth comes into play.
“During the COVID-19 public health emergency, individuals with Medicare had broad access to telehealth services, including in their homes, without the geographic or location limits that usually apply as a result of waivers issued by the secretary, facilitated by the Coronavirus Preparedness and Response Supplemental Appropriations Act 2020 and the Coronavirus Aid, Relief, and Economic Security Act,” the CMS spokesperson said.
According to HHS officials, the telehealth services provide fast and cost-effective communication between patients and providers. But that access could be disrupted during the unwinding process. According to CMS, the telehealth coverage will vary by state.
“For Medicaid and CHIP, telehealth flexibilities are not tied to the end of the public health emergency and have been offered by many state Medicaid programs long before the pandemic. CMS encourages states to continue to cover Medicaid and CHIP services when they are delivered via telehealth,” the spokesperson said.
In hopes to expand telehealth coverage nationwide, CMS has released the State Medicaid & CHIP Telehealth Toolkit, which provides states with assistance to adopt widespread telehealth services.