As the Public Health Emergency Comes to an End, Medicaid Unwinding Begins: What This Means for Health Centers
On January 31, 2020, the Trump Administration declared a Public Health Emergency (PHE) in response to the COVID-19 outbreak that pushed the nation’s healthcare system to its breaking point. Fast forward to 2023, and the Biden Administration recently announced its intention to end the COVID PHE on May 11. The PHE’s end will have significant implications for the Children’s Health Insurance Program (CHIP) and Medicaid, and as a new report from the Geiger Gibson / RCHN Community Health Foundation Research Collaborative explains, the resulting “Medicaid unwinding” is expected to have massive impacts on community health centers (CHCs).
What’s at Stake in the Medicaid Unwinding Process?
Over the past three years, the PHE has implemented vital waivers and policies to expand Medicaid coverage and telehealth coverage. However, HHS predicts that once the COVID PHE has been terminated, approximately 15 million Medicaid and Children’s Health Insurance Program (CHIP) enrollees will lose eligibility.
Medicaid is the largest source of funding for community health centers. Furthermore, according to data published by HRSA in 2021, health centers classified 62.7% of their patients as members of racially and ethnically minoritized populations. Within this same population of patients, 48.4% were covered by Medicaid and 20.3% were uninsured. CHCs continue to provide invaluable primary, dental, mental health, and preventative care services for the country’s most under-resourced communities.
Unfortunately, “Medicaid unwinding” will reduce CHCs from functioning at their current capacity. Recent estimates predict a $1.5 to 2.5 billion decrease in total health center revenue, 1.2 to 2.1 million fewer patients being served, and 10,700 to 18,500 fewer healthcare staff. At a time when the healthcare provider shortage is a public health crisis, our government should aim to offer solutions instead of exacerbating the situation.
How Should Congress Respond?
One critical step the 118th Congress can take to minimize the loss in Medicaid revenue is to increase federal funding for the Community Health Center Fund (CHCF). In 2010, the Affordable Care Act (ACA) established the CHCF to support the Health Centers and National Health Service Corps (NHSC) programs. Now the CHCF accounts for 72% of all federal health center grant funds and almost all of the total funding for the NHSC.
While the future of funding for CHCs remains uncertain, some things remain clear:
- The PHE led to the total Medicaid/CHIP enrollment growing to 91.3 million, an increase of 20.2 million from February 2020 to October 2022.
- During this time, Medicaid grew by 31.1% or 20 million enrollees, which increased the Medicaid revenue that CHCs rely on to provide vital services.
- The end of the PHE means terminating continuous coverage for millions of patients along with a decrease in revenue, patient capacity, staff capacity, and services for CHCs.
- Increasing federal funding for health centers will help mitigate the loss of revenue and services CHCs will experience after the PHE ends.
What Comes Next, and What Can We Do?
Beginning April 2023, states will have 14 months to complete redeterminations and return to pre-pandemic operations. States have spent the past year preparing for the Medicaid unwinding process by improving staffing capacity along with eligibility redeterminations and renewal systems. However, state strategies will have different approaches and timelines which directly impact the speed of redeterminations. Nevertheless, each state should prioritize helping individuals who lose Medicaid eligibility acquire other coverage and reducing administrative “churning” (when Medicaid/CHIP enrollees who are disenrolled and then re-enrolled within a short time period).
Congress is well aware that the PHE is coming to an end. But it is up to the staff and allies of health centers to advocate for the importance of increased federal funding for CHCs and the continuation of PHE waivers and policies that expanded Medicaid coverage and telehealth coverage. Your voice is powerful, and the Association of Clinicians for the Underserved is here to help as we raise our collective voices in support of health centers on Capitol Hill.
Keep up-to-date with the latest developments by joining our network as an advocate and watch for upcoming guidance, action alerts, and more in the near future. Please contact us with any questions or if we can be of assistance in your own advocacy.
President Biden’s State of the Union Address: Eight Health Care Fast Facts
Didn’t have time to watch President Biden deliver his 2023 State of the Union (SOTU) Speech? Here are the Health Care Fast Facts:
- Drug Pricing: The President wants the $35 insulin price cap to include private insurance. Under current law, the Inflation Reduction Act of 2022 (IRA) only has an insulin price cap of $35 per month for people with Medicare. Biden also mentioned other drug cost-reducing provisions within the IRA.
- Medicaid expansion: The President once again asked the 11 non-expansion states to expand Medicaid. Doing so would extend coverage to roughly two million uninsured people.
- Medicare: Biden is committed to strengthening Social Security and Medicare, and opposing any efforts to cut these programs. The President also pledged to “extend the Medicare Trust Fund by at least two decades.”
- Abortion: The President said, “Congress must restore the right that was taken away in Roe v Wade.” He also reiterated his promise to veto any national abortion ban if Congress passes one.
- Opioid Epidemic: Biden wants Congress to expand access to opioid-related addiction treatment. The President also wants harsher penalties for fentanyl traffickers and greater enforcement for the synthetic opioid.
- Mental Health Crisis: The President wants to strengthen data privacy on social media and other tech platforms to protect youth mental health. Biden also wants to increase the number of mental health professionals and first responders.
- Supporting Veterans: Biden called for improving the care for veterans, which includes mental health resources for suicide prevention and combatting homelessness.
- Ending Cancer: The President mentioned the Cancer Moonshot program which aims to cut U.S. cancer death rates by at least half in 25 years. As part of this initiative, HRSA recently awarded nearly $11 million to 22 health centers to improve access to relevant care and screenings.
Updated National Health Service Corps Fact Sheets to Assist Your Advocacy
ACU has released new fact sheets that offer a brief look at the 50-year history and impact of the National Health Service Corps (NHSC). Read our NHSC Program overview to learn about the Corps’ programs, field strength, and funding history, as well as the NHSC’s diversity and professions; and read our NHSC Funding publication to learn further information on the Corps’ funding and the vital need to expand the initiative, which faces a funding cliff after Fiscal Year 2023. Stay tuned for more updates and calls to action to protect, support, and strengthen the NHSC and other vital health extender programs.
Get In Touch
Do you have further questions or need help getting started with advocacy at your health center? Please contact Jordan Marshall, ACU’s Deputy Director of Policy & Advocacy.
