6 Fixes to Improve Medicaid Coverage Access Amid COVID-19

New York’s experience during the Great Recession could inform its approach to coronavirus Medicaid during the pandemic, a recent report from the United Hospital Fund suggested.

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In contrast to the Great Recession of 2007 through 2009, the researchers postulated that New York’s Medicaid enrollment growth may increase because the Medicaid enrollment process is easier than it was during the Great Recession, outreach to eligible individuals is better, and the pandemic has forced people to seek out healthcare coverage.

On the other hand, Medicaid enrollment could slow down because Medicaid covers 10 percent more people pre-COVID than it did before the Great Recession. Additionally, higher-income unemployed populations may delay their switch to Medicaid until after COBRA becomes unaffordable or income drops below other public program eligibility levels.

The researchers recommended six strategies for supporting healthcare coverage in New York during the coronavirus pandemic, based in part on the state’s experiences during the Great Recession.

First, the state should consider further expanding presumptive eligibility, a suggestion echoed by the Kaiser Family Foundation. With presumptive eligibility, patients who seem to fall in the appropriate category for Medicaid coverage can receive care from qualified entities (like hospitals and clinics) even though their Medicaid application has not yet processed.

New York already expanded presumptive eligibility once with an 1135 waiver, but the researchers suggested:

• Expanding presumptive eligibility further to include other institutions like schools as qualified entities
• Expanding groups that qualify for presumptive eligibility to include non-disabled, non-elderly adults
• Conducting a review of hospitals to see which are engaging in presumptive eligibility determinations to promote more usage

Second, the state should enhance its marketing strategy around retroactive Medicaid coverage. Not all eligible individuals realize that, under certain circumstances, Medicaid can cover medical bills three months prior to an enrollee’s application being accepted. The researchers encouraged greater outreach to alert enrollees for whom this might be the case.

Third, while New York has already streamlined Medicaid eligibility and enrollment during the coronavirus pandemic, some of these measures could be implemented for a prolonged period, in the event of a long economic downturn. Such a move would help ensure that enrollees did not lose coverage once the pandemic policies lift. It would bridge the gap between the crisis and the return to normal processes.

Also, New York should also analyze any racial or population-based disparities, the report said.

“Although U.S. Citizenship and Immigration Services announced that any COVID-19 testing or treatment will not negatively affect immigrants as part of a future public charge review, New York might consider whether further outreach is necessary to help immigrants understand how accessing Medicaid or other public programs during the current crisis could affect their future immigration status,” the researchers advised.

Fifth, federal action could help New York and states similarly hard hit by coronavirus maintain residents’ healthcare coverage through economic recovery.

The federal government boosted the FMAP just as it did during the Great Recession, but the move may only amplify financial struggles for states when the enhanced FMAP ends, researchers warned. Thus, the federal government should enact other recovery efforts to continue to buoy states when the economy starts to recover.

The researchers ended by observing that New York should also turn to other states for ideas about coronavirus-era Medicaid strategies. Specifically, they called attention to an Illinois 1115 Medicaid demonstration waiver which allows patients to receive coverage for COVID-19 treatment through Medicaid as a secondary payer.

“While the long-term impacts of COVID-19 on the economy and public health are unknown, Medicaid will remain a vital source of health coverage in the coming months, particularly for those New Yorkers facing challenges to their health and livelihoods worse than those of the Great Recession,” the researchers anticipated. “Sustaining and building upon New York’s progress in improving access to Medicaid will be crucial for serving those in need during these uncertain times.”