How the ACA Can Help Millions who Lost Medicaid Coverage

Introduction

The Affordable Care Act (ACA) offers a lifeline for millions of Americans who have lost their Medicaid coverage this year. As states resume their regular eligibility checks and remove people from their Medicaid rolls, many of them may be unaware of their options to get subsidized health insurance through the ACA marketplaces. The HealthCare.gov sign-up period starting this week could be a chance to enroll them and prevent gaps in their care.

The Medicaid unwinding

The COVID-19 pandemic triggered a federal policy that prevented states from disenrolling anyone from Medicaid, unless they moved out of state or voluntarily withdrew. This policy, known as the maintenance of effort (MOE) requirement, was meant to ensure continuous coverage for low-income people during the public health emergency.

However, the MOE requirement ended on March 31, 2023, and states began to review their Medicaid caseloads and remove those who no longer qualified or failed to respond to renewal notices. As a result, more than 9.5 million people have been disenrolled from Medicaid as of last week, according to KFF.

Some of these people may have found other sources of coverage, such as employer-sponsored insurance or Medicare. But many others may be left uninsured or underinsured, especially if they have chronic conditions or face barriers to accessing care.

The ACA safety net

The ACA provides an alternative way for people who lost Medicaid to get affordable and comprehensive health insurance. The ACA marketplaces, which operate through HealthCare.gov or state-run websites, offer plans that cover essential health benefits, such as preventive services, prescription drugs, mental health care and maternity care. These plans also have subsidies that lower the premiums and out-of-pocket costs for eligible enrollees.

People who lost Medicaid can enroll in an ACA plan at any time through July 2024, thanks to a special enrollment period created by the Biden administration. They do not have to wait for the open enrollment season, which runs from Nov. 1 to Jan. 16 on HealthCare.gov.

However, many people may not be aware of this opportunity or how to take advantage of it. That is why state health officials and health advocates are ramping up their outreach efforts to inform and assist this population.

The outreach strategies

States that run their own marketplaces have more flexibility and resources to tailor their outreach strategies to their specific needs and populations. For example:

●      California: 

○      California automatically enrolls certain people leaving Medicaid into marketplace coverage and covers the first month's premium for them. 

○      It also uses a "bridging the gap" theme for its open enrollment messaging, emphasizing the continuity and affordability of coverage.

●      New Mexico: 

○      New Mexico made 157,000 automated calls and sent 220,000 text messages, along with thousands of emails and personal calls, to people who lost Medicaid. 

○      It also held outreach events in Spanish, online and in communities.

●      Maryland

○      Maryland launched a "Don't Get Dropped" campaign that features testimonials from former Medicaid enrollees who switched to marketplace plans. 

○      It also partnered with local organizations and health providers to reach out to potential customers.

●      The Federal Government: The federal government also coordinates with states and local partners to connect people who lost Medicaid with ACA coverage options. 

○      When a state determines someone is no longer eligible for Medicaid, it transfers their information to the federal marketplace, which may then contact them by mail, email or phone.

○      The federal marketplace also helps link them with local "navigators" who can provide free and unbiased assistance with enrollment.

The challenges and opportunities

Despite these efforts, there are still challenges and barriers that may prevent some people from getting ACA coverage after losing Medicaid. Some of these include:

●      Lack of awareness or confusion about the availability and affordability of ACA plans

●      Difficulty navigating the enrollment process or providing the required documentation

●      Mistrust or fear of sharing personal information or seeking health care due to immigration status or other factors

●      Limited access to internet, phone or transportation services

●      Competing priorities or stressors related to the pandemic or other life circumstances

To overcome these challenges, state and federal officials and health advocates need to continue and expand their outreach and education campaigns, using multiple channels and languages to reach diverse audiences. They also need to provide clear and accurate information about the benefits and costs of ACA plans, as well as the enrollment deadlines and procedures. Moreover, they need to offer personalized and culturally competent assistance and support throughout the enrollment process and beyond.

The ACA sign-up season starting this week presents a unique opportunity to enroll millions of people who lost Medicaid into quality and affordable health insurance. Doing so would not only improve their health outcomes and financial security, but also reduce health disparities and strengthen the health system as a whole.

References

1.     Goldman, M. (2023, October 30). As millions lose Medicaid, ACA sign-up season may help. Axios. Retrieved from 1.

2.     Reed, T. (2023, October 30). Federal coverage of COVID drugs ending. Axios. Retrieved from 2.

3.     Owens, S. (2023, March 30). Judge strikes down Affordable Care Act preventive services mandate. Axios. Retrieved from 3.

4.     Collins, S. R., Gunja, M. Z., & Aboulafia, G. N. (2023, March 16). Inequities in Health Insurance Coverage and Access for Black and Hispanic Adults, 2013-2019. The Commonwealth Fund. Retrieved from 4.

5.     Medicaid.gov. (n.d.). Unwinding and Returning to Regular Operations after COVID-19. Retrieved from 5.