Losing Medicaid in PA - Recording of Educational Webinar

Video Transcript:

Before we get started, I do wanna say thank you.

Obviously, it's a very important topic, Pennsylvania as a whole, normally has individuals across the state that are traditionally Medicaid eligible due to a myriad of reasons. And that number as far as Pennsylvania as a whole, we have 12 million people in the Commonwealth. One million was kind of the floating number prior to the pandemic of individuals that were on some kind of Medicaid or chip program. Today, we're at three million, closer to 3.5 million individuals.

My goal today is to talk about if we're going to have potentially two million people impacted by the end of the public health emergency, what the next steps are and for some people that were on Medicaid prior to the pandemic, let's say in 2019, their coverage with Medicaid may have extended into 2020 and they may have been on this for Medicaid for four years.

Transparency

Now, we also want to touch on some changes to the laws that actually improve access for consumers before we get started.

The first thing I will say is this is not meant to replace any legal advice or any tax advice out there. We're also not a government agency. I'm holding this meeting primarily because I am on the Pennie Policy and legal working group within Pennie and I'm on a working group within CMS. We're very close to the discussions regarding what is happening in Medicaid. And the limit to what we're talking about today is Pennsylvania. Some of this may be applicable in other states. But the topic today is really around what's happening in Pennsylvania.

About

We're gonna talk about a high level view of Medicaid and eligibility that's going to help us as we talk about what else is out there and what happens after Medicaid and then we're going to get into those regulation changes and do a brief recap and then I will stick around for a question and answer at the end.

About Medicaid

As far as Medicaid, if you've been on it, you're, you're certainly aware that at least at the highest level, generally, if you're eligible for Medicaid, it is zero monthly premium, zero, deductible, zero coinsurance.

And generally speaking, you are going to be faced with copays. It's really gonna depend on the plans that are available in your county and the treatment that you seek. But in general, the benefit to being in Medicaid, especially through a pandemic is stability, right?

It's, it's really about making sure that if you do need to go to the doctor that there's not an impediment to access and especially when we're talking about a global event related to health.

Eligibility

Really, if, if you're eligible and you have a need for Medicaid, then you should be in that program. But what had happened is during the pandemic, what normally we see with case workers is that they have four core requirements.

They have to focus on applications that come in, that they have to on board and ask questions to families about their income and their house dynamics.

They're responsible for in staff assistance every six months, renewing the file in health insurance benefits every 12 months, renewing the file and off boarding when someone's no longer eligible because their income is, is too high or their resources have changed. And Medicaid just isn't the fit anymore as the pandemic came along, the two things that kind of went away were monitoring and routing and, and monitoring. Really what we're talking about there is if you're getting W-2 wages and your employer reports to the state that income is monitored by the Medicaid system when you file your taxes and the IRS reports that there is a new tax return on file. They monitor that what you've reported in the past is correct.

During the pandemic that went away, we went from a million people to 3.5 million people. And the reality was during this pandemic. Once you were in, you were in right. There was no routing you to Pennie or to any other program and, and they couldn't afford to kick people off. Especially when you look at 2020/2021 if you imagine losing a job getting eligible for Medicaid, getting a new job, getting kicked off. Medicaid a shutdown where you lose that job again. It just didn't make sense to monitor when so many people needed help during the pandemic.

Public Emergency

Those two things really went away in addition to that, the state got money from the federal government. Now this I I know we all love graphs but this is pretty substantial. Normally when it comes to paying for benefits. Medicaid costs is a cost that is shared by the federal government, the state and the local municipalities. And what happened during COVID, you can see here in 2019 is about half of the cost of Medicaid was picked up by the federal government. And during the pandemic, the government's been giving an extra about 6% to the state to keep people on Medicaid. Not only was it in the best interest of everyone to stay put while we were dealing with this phenomenon, but there was a financial incentive for states to keep consumers where they were at.

The rule book over the last three years has been, you could have a change to your income. You could even have a change to your life. A child on chip, aging out of chip because they're now 19 or 20 you could have someone on Medicaid that turned 65 is now eligible for Medicare.

Unwinding

The reason we're having this conversation today is at a federal level, we've got 18 million people about to be rerouted somewhere. And it's kind of like where everyone's gonna shift or sift down into where they ultimately should be the concern ends. The second column, which is right now, our, our number one concern people that lose Medicaid or half of them are going to be eligible for coverage through an employer. One in six are Children who are gonna be eligible for low or no cost chip. There are all of these different avenues that people can wind up in. But the concern right now is we've got 3.8 million people across the country that may not wind up where they need to go. So that's the whole purpose behind today's conversation is we wanna make sure that you understand which bucket you should be falling within and really address how that process is going to happen and dispel any misunderstanding across the board.

In order to get into that, we're gonna talk about charts, right? We started with graphs. Now we're moving on to charts.

Don't stress what I will say first is if we ignore the white bubble, you're gonna see that November, December and January are nothing more than open enrollment that comes every year. We get an influx of notices from Pennie. Those three events happen and the last event which is March 31st is the end of the unwinding period.

Essentially what is happening is we have a lot of people that need to be reshuffled either to an employer or to chip or to Pennie or wherever they need to go. We need to make sure that no one has messed along the way. We need to make sure that they're moved to the right, the right it, the government realizes both at the federal and the state level. We need time.

Not only that, the federal government and the states don't want everyone to be reevaluated in April for the last several years.

We've been waiting on the end of the pandemic and what we came up with at a federal and state level is that when it's determined to be the end of the pandemic, we have a lot of people that need to be mapped to their destination. There's a 12-month period that we're going to have to reevaluate individuals. Normally, when it comes to Medicaid, when I was talking earlier about the responsibilities of the county, they help people when they onboard and they help people at the 12-month mark of the renewal. That is exactly how it's going to work with Medicaid if you are receiving your Medicaid renewal and it's normally in the fall, it's normally at a different time of year, you're not going to be in this first batch of individuals. What they're not going to do is take 2.5 million people and reroute them all at once.

What they are going to do is they're going to take everyone that normally renews in April and they're going to renew them, everyone that in May, they're going to look at everyone for May so on and so forth. And the way that they're doing it is if your 12-month period comes up in April, you would have already gotten notices in the mail that they are going to be reviewing your application from April 1st to May 1st.

We've got 30 days where the caseworker is reviewing that application and determining... Do you still fit?

Should you be one of the million that are eligible for Medicaid or should you be mapped outside of the Medicaid system in that time period? Once you submit your documentation, just like you do for any renewal, they're going to send you a determination letter which could be another week or two. That's why we have May 15th there and it's going to give you on that letter, the notice that you're no longer eligible and the date that your coverage will end it is not tomorrow that I lose coverage. It's not the day after the letter comes in. It's not two weeks before it is going to be systematic.

Your month comes up, you submit documents, they have 30 days to renew the file. They send you a letter and then you lose coverage and that losing coverage will address in a bit, but it allows you to enroll in something else. It is what we consider a qualified life event and a qualified life event allows you both on the employer and the individual side to enroll in another plan without having to worry about eligibility, even if it's a mid-year.

That addresses the first 60 days in the individual market, which is Pennie in our state. They're actually giving you 120 days from when you receive that notice to when you have to enroll in a plan when your qualified life event ends. So it's going to be systematic. You're going to get a 90-day notice to let you know that your file is coming up. You're going to get a 60-day or a 30-day notice that tells you that they're going to start reviewing your file.

Here's what they need.

You're gonna get a notice to submit documents and renew and if you're eligible, then you have another 12 months of coverage through the Medicaid program or six months. If you also have snap assistance and you have to do the renewal, then if you are found ineligible, you will be passed either to Pennie or given a life event where you can enroll through an employer.

Next Steps

The number one thing we're being told by Medicaid today is their concern is with accuracy what they actually have on file.

So again, going back to March of 2019, any of the people that enrolled in March of 2019 in Medicaid, their file would have come to March of 2020 in the pandemic. It would have automatically be swept in or coverage for subsequent years. It is quite possible that you've moved, that you're using a different email that your phone number changed.

The problem is if they're sending them to a wrong address or they, they don't have the right phone number on file to be able to text or email, then the people that don't have their information up to date aren't gonna find out that they lost coverage until they go to use their insurance at a doctor's office as the worst position that we don't want anyone to be in either log in to compass or call the statewide customer service number and just make sure your contact information is up to date.

Routing - Group

As far as employer-based coverage, like I said, when you get that letter saying that you're no longer eligible for Medicaid, that is all you need to speak to your hr department, and to be added to an employer plan, that is your qualified life event.

You have a letter that specifically says you're no longer eligible as of XX date. That's all they need to allow you to get access to coverage through the group.

Now, I want to clarify two points when it comes to group-based coverage.

Number one, there's an assumption that if I have coverage through work that my kids can no longer get CHIP. Every single child who's 17 and under is eligible for if they're covered by an employer plan, meaning you check the box that says I want them on my plan. I'm picking the family plan and I will have everyone under one roof, then CHIP will decline access because they do a search and they see that they're covered elsewhere.

However, as you're reviewing, going back on an employer plan, you may want to check if CHIP is going to be more cost-effective than putting them on the plan. But there are certainly scenarios where you wanna compare. Does it make sense to put everyone on a plan through my employer or does it make sense to pick CHIP?

The other thing I wanted to add is that October of this past year, there was a new law that was passed that allows families to determine if it makes sense to have everyone through the group plan historically, prior to last October, if your employer offers a plan and I use that example again, where, let's say, it's $100 for you, $600 for you and a spouse, $1,200 for you and your family and you look at that and you go, that's not affordable.

The fact that the employer offered something affordable to the employee... i.e. the $100 a month that was considered that household has access to affordable coverage.

That's how the law defined it.

Everyone else would either have to take the plan through work or if they took a plan through Pennie or through an insurance company, they could not get tax credits. And this law was passed in October if the plan is $100 for you.

Great. As the employee, you should take that. But if it's $1,200 for your family, and that's more than 8% of your income, then the rest of the family can actually opt out and can get tax credits through Pennie.

Keep in mind -- One, you may be able to keep your kids outside of the employer plan through CHIP at an affordable rate. Two, you may be able to look at an alternative where you enroll in the plan through work and the rest of the family considers a plan through Pennie.

Routing - Pennie

As far as Pennie is concerned, what is happening is when Medicaid determines that someone is no longer eligible, they're handing the file over to Pennie. That creates a special enrollment period so you can enroll in a plan.

What Pennie did put in place is normally when there's a qualified event, Pennie has a 60-day window to enroll in coverage... they've extended that to 120 days which I have mentioned before. You have the ability to take your time and pick a plan that really suits what your needs are.

In addition to that, if you get that letter in the mail from Medicaid and you lose coverage -- the first 60 days after a loss, you get to choose when the new plan starts and that's crucial when we're talking about time. And we're talking about this being something that is new to a lot of people that they haven't dealt with in years. Pennie allows you to retroactively have coverage.

In the first 120 days after you get the letter that says you're no longer eligible, you can pick a plan on Pennie and be covered. If you do pick a plan and you do it within the first 60 days after that letter, they're able to retro-act coverage even if you came back.

Let's say it was June 15th. Let's say it took you a while to check all your doctors and check your medications, and just do your research and make sure that the plan you want to be in makes sense. Normally, if you enroll in a plan, the coverage would start the next month. Normally what would happen is June 15th, you would enroll in a plan July 1st, you would start coverage and you could potentially be at risk of a, a medical bill during the month of June not being covered. What Pennie basically did is they said if it's in the first 60 days and they do an enrollment on June 15th, for example, Pennie will allow that to be a start date of June 1st. There's no gap in coverage.

You don't have to worry about the pressure of making a mistake.

Do your research, check the plans and they're giving you time again. On the resources page is a link that explains that in more detail, directly from Pennie.

The other two points that I have on here -- number one is right to contact in the event you don't call, you don't do something, they're going to call you within 30 days. For some people, that's a sigh of relief and they are gonna wait for the call for other people that don't necessarily want to get more calls.

If you start the process in the first 30 days, you're not going to get an outside person trying to get you enrolled in a plan.

The last thing is in March of 2021, there was a federal law that was renewed in August of '22 as well. Prior to this law, there were two things. Number one, if your income was over a certain threshold, you were not eligible for tax credits at all. If you were a dollar under the cliff, you got support, you got lower premium and if you were a dollar above the cliff, you would not be eligible. Well, with the new law, that cliff is gone, the credit that you get. The amount of help that you get with finding insurance at an affordable rate is based upon the household income without a cliff. So it is less and less, the more you make.

But if there's not a cut-off where you are either eligible or not, the second thing that was put in place in that law, and again, renewed in August of 2022 was additional tax credits. Basically, they supercharged it to where in the past people would pay a lot more. The same plan that today might be $10 or less per month.

If you don't have coverage through some other means and you're, you're looking at coverage through Pennie, you're going to notice that the rates are much more affordable than they were in the past.

Conclusion

The big takeaways today --

Don't stress, check your contact information on compass or by calling the Department of Health.

Don't rush to get your application renewed. If it's in the fall, let it be in the fall. These caseworkers are already trying to figure out how to do 250,000 red determinations a month. You will be given plenty of time to re-acclimate with ample time to do your research and to understand what the next steps will be and you're not alone if you have any issues, ask for help.

We're doing outreach with the county assistant caseworkers as well. We're always here as a resource. Pennie is here. Generally speaking, I try to explain that there are limits to what a front-line customer service person at Pennie will know and what they can say and not say.

Normally it's finding an individual broker that can look at it objectively and, and give you some insight, just ask for help.

Resources

As far as the resources are concerned, you can take a picture of that QR code and download the PDF . These are really, tools that I would say to keep in your back pocket.

The first one is an FAQ from the Department of Health. Any question that you could think of, they've probably given an answer to and put it in that FAQ, they've been working on that for the last year and a half.

The second one is any communication that they are planning to send the 90-day notice, the 60-day, 30-day notice, that you've been enrolled, your eligible notice, any text messages, any emails, anything the government is going to send you at the state level. They have a list at that link that if you get something in the mail and you're not sure if it's actually from the Department of Health, it seems a little fishy or maybe you just like to be proactive and know what's coming to you. That link has every single notice that's gonna be sent. It's a good resource to have.

The third one is the statewide customer service line [1-877-395-8930] for people that can't get a hold of their local county. That's always a good resource.

The fourth one is that calculator that I was telling you about where you can check if the plan through work is portable.

And the last one is our link if you need help. And you want to ask, this is where you can start with us.

Thank You

Thank you guys for, for sticking around. And I hope this answered a lot of different questions that you may have had, feel free to reach out at hello at my snap health dot com or give us a call if you have any questions.