Rebooting the state’s Medicaid program could push 38,000 people in Spokane County out of insurance coverage later this year.
With the federal public health emergency decree for COVID-19 set to end in May, states are returning to normal operations for their Medicaid programs. In Washington, the program is known as Apple Health.
Those normal operations include stopping continuous Medicaid enrollment. During the pandemic, about 300,000 people in Washington – including 38,000 in Spokane – were kept on the government insurance program designed to provide medical coverage for poor people, regardless of whether they took higher-paying jobs or failed to respond to eligibility inquiries.
People on that continuous enrollment after April 1 will have to renew their eligibility for Medicaid for the first time in three years.
Most will get renewal notices in May, June and July, said Amy Dobbins, a Washington State Health Care Authority Medicaid eligibility section manager.
“In March of 2020, it was the Families First Coronavirus Response Act that really implemented that continuous enrollment requirement for anybody who was active on Medicaid or became active on or after that effective date,” Dobbins said.
“So states had to keep folks open regardless of changes to income. In that Families First act, the states could get enhanced funding if they continued coverage for people through the end of the Public Health Emergency.”
While some people among the 300,000 may no longer qualify after April 1, others who had continuous enrollment might retain Apple Health if they still meet Medicaid eligibility and answer the upcoming notices, Dobbins said.
During the past three years, the overall number of people with Medicaid coverage statewide also grew. Prior to March 2020, about 1.8 million people were on Apple Health in Washington, and it’s now just under 2.3 million people statewide, Dobbins said.
Under the COVID provisions, the health care authority could stop continuous coverage after a death, or if someone moved out of state, requested removal or didn’t provide information to verify identity. But in most cases, even if people didn’t respond to notices since early 2020, the agency had to continue coverage because of the federal requirements, she said.
“If they came through and it looked like they were no longer eligible, or if they never came through, we just extended their coverage by three months at a time throughout the last three years,” Dobbins said.
“The 300,000 is mainly people who haven’t responded to letters to renew their coverage. It’s also people who came through and said they had income over the standard, and we had to do some manual work to make sure that their coverage stayed open. That federal regulation required us to keep them covered.”
What’s different is in another month, people under continuous enrollment will receive one last three-month extension, she added, “which is why those first three months will be the highest volume for just the 300,000 … but we’re still also running renewals for everybody else.”
The state sends notices in advance of a person’s renewal date during the 12 months. People with continuous enrollment who are found ineligible could lose their coverage as early as April 30, but more likely at the end of May.
It’s difficult to estimate how many among the 300,000 might lose coverage, until responses are or aren’t received, Dobbins said.
If their Apple Health coverage ends, people can search for a plan on the state health insurance exchange, wahealthplanfinder.org. The agency is seeking volunteer ambassadors to help people update their insurance or respond to renewals. Ambassadors might be at health care clinics, schools, government offices or community centers.
Caitlin Duffy, director of business development and sales at Community Health Plan of Washington, said the not-for-profit organization has geared up to help before people lose Apple Health coverage. The nonprofit is among outlets providing Apple Health, Medicare Advantage and individual and family health plans.
A similar agency in Spokane is Better Health Together.
Duffy said Apple Health enrollment rose significantly during the pandemic.
“Part of the reason for this is no one was kicked off of Apple Health, and typically you’d see some natural churn where people come off and on Apple Health depending on their eligibility in the last three-plus years,” Duffy said. “We really haven’t seen any of that because the state has to allow for that continuous enrollment, while more and more people have become eligible for Apple Health.”
She said that Spokane County had nearly 200,000 total Apple Health clients as of Jan. 25. Among them are the nearly 38,000 on a continuous enrollment status.
“These are the people most at risk of losing their Apple Health coverage because they have either not sent in any sort of documentation showing they’re still eligible over the course of the last three years, or they did send in some documentation or completed a renewal and the state internally flagged them as potentially no longer eligible.”
There are proactive steps to take, Duffy said, such as updating Apple Health contact information; checking mail and email frequently for notices from the state; and completing a renewal form to avoid loss of coverage.
If Apple Health coverage ends, there are affordable options on the state’s health plan exchange, she said.
“Many of these plans have subsidies and other cost-share savings that drop the premium to sometimes lower than $10 per month.”