With pandemic emergency set to end, MaineCare members must prove eligibility to keep coverage

An estimated 89,000 low-income residents who have had health coverage during the pandemic through MaineCare, the state’s Medicaid program, could begin to lose their coverage this coming spring when the Biden administration ends the public health emergency.

That is because Congress, in an omnibus spending bill passed in December, has initiated the phaseout of a pandemic-era safeguard that allowed enrollees in Medicaid and CHIP, the Children’s Health Insurance Program, to not complete the renewal process to maintain coverage. 

Before the COVID-19 pandemic, Medicaid recipients were required to renew an eligibility application every year. But in March 2020, Congress included a “continuous coverage” rule in the first COVID relief bill that increased funding for the states to allow Medicaid recipients and young people covered by CHIP to continue receiving health coverage even if they lost eligibility due to a salary change or they aged out of the program. 

The continuous coverage rule was to stay in effect as long as a public health emergency was declared.

With President Joe Biden intending to lift the public health emergency in May, Congress set March 31 as the end of the continuous enrollment requirement. Redeterminations of eligibility will start in April and will happen over the next 12 months.

The end of the public health emergency also means that many Americans could have to start paying for COVID-19 testing and treatment.

The phaseout of continuous enrollment will allow states to cull their Medicaid rolls and throw an estimated 5.3 million to 14.2 million enrollees off public health insurance, according to an analysis by the Henry J. Kaiser Family Foundation. The analysis estimates the largest losses will be among adults who got onto the rolls after the Affordable Care Act of 2010 allowed states to expand eligibility to people within 138% of the federal poverty line.

The Urban Institute estimates that Maine could see a loss of 89,000 or 22.5% of the MaineCare and CHIP population during the re-determination process between April 2023 and June 2024.

Maine is one of 14 states expected to be most impacted by the end of the public health emergency. According to the Urban Institute, Arizona, Colorado, Florida, Idaho, Indiana, Maine, Minnesota, Nevada, New Hampshire, North Dakota, Utah, Virginia, Wisconsin and Wyoming are all estimated to see a 20% or more reduction in Medicaid enrollment.

MaineCare enrollment ballooned during the pandemic — in part due to the continuous coverage rule. Voter-approved Medicaid expansion, which began in 2019, and the economic downturn during the pandemic also made more people eligible for public health insurance. In February 2020, 267,482 residents were enrolled in MaineCare. That number climbed to 356,933 by September 2022. 

The continuous coverage safeguard temporarily eliminated a longstanding problem with Medicaid enrollment numbers known as “churn,” where enrollees experience gaps in coverage because of annual renewal requirements. Churn often happens because a person experiences a short-term change in income that results in them being temporarily disenrolled. They must then reapply. 

An analysis found that enrollees who experience fluctuations in coverage are more likely to report difficulties getting medical care and are more likely to end up in the hospital with a preventable condition. Churn also increases administrative costs for the states. It is an example of what experts describe as a “bureaucratic” or “administrative burden,” which by design makes safety net programs difficult for people to access.

There are also problems associated with states restarting annual renewal processes after almost a three-year hiatus, such as administrators not having up-to-date contact information for enrollees. This could result in eligible individuals losing coverage because they did not receive renewal notices, and therefore they may not take action to return necessary paperwork to the state.

Aware of the upcoming coverage cliff, local aid groups say they are working with administrators to make sure Mainers are notified.

“It’s the responsibility of each state, including Maine, to make sure people know when and how to complete their MaineCare redeterminations, but this will need to be a team effort,” said Alex Carter, a policy advocate with Maine Equal Justice, an economic justice organization that helps low-income people access safety net programs.

Carter said Maine Equal Justice and other local organizations are working with the Maine Department of Health and Human Services “to reach MaineCare members so that those who are still eligible don’t lose their coverage and those who are no longer eligible can access coverage through the state-based marketplace.”