It’s gonna be YUGE mess in the states ans the ‘social/health safety net’ drops away….
The first coronavirus relief law, in March 2020, offered states a bargain to help them cope with the sudden spurt of Americans losing jobs and health benefits that accompanied the worst public health crisis in a century: The federal government would give states extra money to help pay for Medicaid if they promised not to move anyone off the program as long as the emergency lasted.
Every state accepted the bargain at a moment when few imagined that, two years later, the pandemic — and the public health emergency the Department of Health and Human Services has been renewing every 90 days since the coronavirus’s first winter — would still be present. In that time, Medicaid caseloads have jumped about 22 percent nationally as new people have joined and no one has cycled on and off the rolls. The nearly 78 million Americans on Medicaid as of September, the latest figure available because federal tallies run months behind, are the most since the program began as a shared federal-state responsibility in the 1960s as a pillar of President Lyndon B. Johnson’s War on Poverty.
Once the federal emergency is lifted, every state will need to reassess its entire bloated roster. Many of the people who will be removed from the safety-net insurance probably will qualify for private health plans, according to Biden administration officials and health-care researchers and advocates.
But large questions hover over how many beneficiaries whose incomes have risen above Medicaid’s eligibility thresholds will simply disappear instead of sliding over to other insurance. And it is unclear how many who remain eligible will be removed from the program improperly.
For Biden health officials, helping states get ready for this enormous task — dubbed “unwinding” from the health emergency — has been a preoccupation for several months. They have sent states a detailed punch list of recommended steps to take in preparation, dispatched letters spelling out federal expectations and continued to confer often with each state….
The extra federal money will last no more than three months after the public health emergency ends. After that, states will have to shoulder a bigger portion of the costs associated with their swollen Medicaid caseloads while finishing the unwinding….
The administration and congressional Democrats have tried to create a cushion to deter states from unwinding quickly to save money. The cushion, part of a far-reaching social policy bill, would ratchet down the extra federal payments more gradually. But the legislation, called the Build Back Better act by its enthusiasts, is stalled on Capitol Hill.
One state’s experience with a similar insurance program offers a preview of what can go wrong if states move too fast. In Utah, a federalinsurance program for children from working-class families was initially handled in a fashion similar to Medicaid, with all children kept in the program during the pandemic. Last year, the state reversed course on the Children’s Health Insurance Program — widely known as CHIP — scrambling in two months to send renewal notices and make new eligibility decisions. More than 40 percent of Utah children on CHIP were dropped.
“It ended up being a disaster,”…..