Medicaid "Unwinding" for Groups, ACA and Bill the Cat

[Duaine]

http://henrystrongingoldberg.blogspot.com/bill_the_cat.gif

Anticipated 2023 State Timelines for Initiating Unwinding-Related Renewals
As of February 24, 2023

See attached.[EXTERNAL LINK] - ant-2023-time-init-unwin-reltd-ren-02242023.pdf | Powered by Box

 

[somarco]

OK, I had no idea what this "Medicaid unwinding" was all about . . . partly because that is not part of my market.

So I had to ask "the Google" . . .

At the start of the pandemic, Congress enacted the Families First Coronavirus Response Act (FFCRA), which included a requirement that Medicaid programs keep people continuously enrolled through the end of the month in which the COVID-19 public health emergency (PHE) ends, in exchange for enhanced federal funding. Primarily due to the continuous enrollment provision, Medicaid enrollment has grown substantially compared to before the pandemic
https://www.kff.org/medicaid/issue-...the-medicaid-continuous-enrollment-provision/

This explains why the lame stream media is screaming about millions who will lose their health insurance unless DC acts to correct the problem.

The Treasury printing presses are running overtime . . .

 

[DonP]

http://henrystrongingoldberg.blogspot.com/bill_the_cat.gif

Anticipated 2023 State Timelines for Initiating Unwinding-Related Renewals
As of February 24, 2023

See attached.[EXTERNAL LINK] - ant-2023-time-init-unwin-reltd-ren-02242023.pdf | Powered by Box

10 million plus non poverty people who lost their jobs at the beginning of covid jumped on Medicaid and are still on it . Many of these people had kids and are still on it yet working . But the unintended consequences is the 100’s of thousands of dual and partial duals that easily qualify will be knocked off . They don’t have the education to fill the forms out or many have moved the last 3 yrs and won’t get the forms . So many of these people will lose their dual plans and be disenrolled and go back to orginal medicare . Some I’ll help get new non duals . Some will reapply for Medicaid and get . I’m not a social worker but will help any person fill the forms out on phone to stay on Medicaid . But anyone who loses dual status I’m not rewriting unless they call me . I’m reducing my exposure to this mkt . It takes way to much time .

 

[Truce]

10 million plus non poverty people who lost their jobs at the beginning of covid jumped on Medicaid and are still on it . Many of these people had kids and are still on it yet working . But the unintended consequences is the 100’s of thousands of dual and partial duals that easily qualify will be knocked off . They don’t have the education to fill the forms out or many have moved the last 3 yrs and won’t get the forms . So many of these people will lose their dual plans and be disenrolled and go back to orginal medicare . Some I’ll help get new non duals . Some will reapply for Medicaid and get . I’m not a social worker but will help any person fill the forms out on phone to stay on Medicaid . But anyone who loses dual status I’m not rewriting unless they call me . I’m reducing my exposure to this mkt . It takes way to much time .

You are most definitely a social worker Don.

 

[wehotex]

You are most definitely a social worker Don.

Don,
If you helped them, at least you would get Double pay as a new to MA rate.

 

[Yagents]

But anyone who loses dual status I’m not rewriting unless they call me . I’m reducing my exposure to this mkt . It takes way to much time .

Awe, he sees the light !!

 

[kgmom219]

There's a bit more than just Duals to the PHE ending. Even though there are 12 million Dual Eligible Seniors.

1. The waiving of Under Observation to SNF rules are back
2. Freestanding ER's will no longer be covered for Medicare
3. Original Medicare: In Office tests covered at 100%. Paxvolid covered but its plan specific.
4. MAPD: Plan Specific.
5. Groups: Plan Specific, but the vaccine will most likely be subject to cost sharing.
6. OM and MAPD: Vaccines covered at 100%
7. ACA has a 14 month SEP. (Which is nuts, but whatever)
8. Groups have a 60 day window from date of termination

Seniors who are dual eligible make less than $1100 a month with $7K in the bank for most states. Losing Medicaid means they are not only going to show up at the pharmacy and need to pay, their SSA check will be $165 lower than the last month. And since they didn't go through re-determination, they probably lost food stamps, too. So basically, its a s**tshow and our most vulnerable seniors are going to suffer.

And its not all about "poor" people.

Its about the kids who are "non-MAGI" medicaid due to a diagnosis, like Down's Syndrome.

Its about the kids who were in Foster Care, have aged out of the system and never created an account at their states HHS site. They are about to lose coverage, too. With no notification in the states that are not allowing the carriers to take a lead on notification.

What they SHOULD do (if they let me run the world) is direct the PBM's to print the alert and phone number on every prescription that's filled for a Medicaid patient. That's a quick and easy fix, for all the people getting prescriptions. So you know...the sick ones.
(And don't tell me they can't do this unless you have also worked at PBM, written the damn programs and the tested the results. I have.)

This is going to get really ugly, really quickly. My advice is that even if you don't work in this arena, pass out the information when you can. I will be dropping off the TX HHS flyers at my local Goodwill and food bank the first week in April. Tell your churches, especially if they have food pantry's. Getting the word out, even if you don't have Duals is the right thing to do.

And if you have Duals, get on it. I have a whopping 3 of them and even more ACA with kids sent to Medicaid/CHIPS due to income. I think there are 10 or so on my groups where I had them put the kids on CHIPS. They are all getting an email the last week of March to schedule a call after April 1 to let them know what is going on and make sure that the information at the state HHS is up to date.

Do the right thing. Works every time.

 

[DonP]

There's a bit more than just Duals to the PHE ending. Even though there are 12 million Dual Eligible Seniors.

1. The waiving of Under Observation to SNF rules are back
2. Freestanding ER's will no longer be covered for Medicare
3. Original Medicare: In Office tests covered at 100%. Paxvolid covered but its plan specific.
4. MAPD: Plan Specific.
5. Groups: Plan Specific, but the vaccine will most likely be subject to cost sharing.
6. OM and MAPD: Vaccines covered at 100%
7. ACA has a 14 month SEP. (Which is nuts, but whatever)
8. Groups have a 60 day window from date of termination

Seniors who are dual eligible make less than $1100 a month with $7K in the bank for most states. Losing Medicaid means they are not only going to show up at the pharmacy and need to pay, their SSA check will be $165 lower than the last month. And since they didn't go through re-determination, they probably lost food stamps, too. So basically, its a s**tshow and our most vulnerable seniors are going to suffer.

And its not all about "poor" people.

Its about the kids who are "non-MAGI" medicaid due to a diagnosis, like Down's Syndrome.

Its about the kids who were in Foster Care, have aged out of the system and never created an account at their states HHS site. They are about to lose coverage, too. With no notification in the states that are not allowing the carriers to take a lead on notification.

What they SHOULD do (if they let me run the world) is direct the PBM's to print the alert and phone number on every prescription that's filled for a Medicaid patient. That's a quick and easy fix, for all the people getting prescriptions. So you know...the sick ones.
(And don't tell me they can't do this unless you have also worked at PBM, written the damn programs and the tested the results. I have.)

This is going to get really ugly, really quickly. My advice is that even if you don't work in this arena, pass out the information when you can. I will be dropping off the TX HHS flyers at my local Goodwill and food bank the first week in April. Tell your churches, especially if they have food pantry's. Getting the word out, even if you don't have Duals is the right thing to do.

And if you have Duals, get on it. I have a whopping 3 of them and even more ACA with kids sent to Medicaid/CHIPS due to income. I think there are 10 or so on my groups where I had them put the kids on CHIPS. They are all getting an email the last week of March to schedule a call after April 1 to let them know what is going on and make sure that the information at the state HHS is up to date.

Do the right thing. Works every time.

The carriers have almost been silent on this . The Rd’s know nothing . I’m not understanding if state Medicaid is doing the redetermination automatically or are they sending forms for all to fill out before determining if their eligible ?The way I’ve read it it acts like unwinding will be quick and it’s predetermined? Most of my people are still eligible but the biggest problem is the uneducation to fill the forms out . Also I didn’t know you could have $7 k of assets and still be full dual ? I thought it was $2k ?

 

[kgmom219]

The carriers have almost been silent on this . The Rd’s know nothing . I’m not understanding if state Medicaid is doing the redetermination automatically or are they sending forms for all to fill out before determining if their eligible ?The way I’ve read it it acts like unwinding will be quick and it’s predetermined? Most of my people are still eligible but the biggest problem is the uneducation to fill the forms out . Also I didn’t know you could have $7 k of assets and still be full dual ? I thought it was $2k ?

Welcome to the world of cluster and ****.

1. Its state specific on the guidelines.
https://ccf.georgetown.edu/2022/09/06/state-unwinding-tracker/
2. Most states are doing both mail and email campaigns
3. UHC is reaching out in the states where its allowed (there was an email last week) and the AOR is supposed to hold. (It won't but at least this presumes they will fix it). We haven't heard from anyone else
4. Information can start being sent on 4/1 with the first terminations occurring on June 1.
5. Carriers can do what's called "deemed eligibility" for a period of 6 months. The only one who does it (as of today) is Humana-for 3 months
6. If they are kicked off a dual MAPD plan, the carrier is required to enroll them in a Part D plan.
7. Non-MAGI Medicaid (what I like to call Diagnosis Medicaid) is not supposed to have to go through re-determination. Uh huh.
8. Its not going to be quick and there is nothing automated about it
9. There are serious issues with staffing nationwide at every HHS office

In a nutshell: If they've got Medicaid, they are going to need to go through the re-determination process.

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