Advocacy Update – May 2023: What Does the End of the Public Health Emergency Mean for Medicaid?

UMDF Washington Update – May 25, 2023

Debt Limit Negotiations Continue  

House Speaker Kevin McCarthy (R-Calif.) met with President Joe Biden on May 22, 2023, and had a “productive discussion,” but they have not yet reached a deal on raising the U.S. debt ceiling. Notably, President Biden and Speaker McCarthy are facing an upcoming deadline known as the X-date as they continue their debate to increase the federal debt ceiling. According to Treasury Secretary Janet Yellen, the X-date – the day the U.S. government says it can no longer fulfill all its financial obligations – is rapidly approaching. Yellen contends that “it is highly likely” the U.S. Department of the Treasury won’t be able to pay all the bills in early June, potentially “as soon as June 1.” The debt ceiling is a limit set by Congress on the amount of borrowing the Treasury can do, currently $31.4 trillion. Breaching the debt limit is not the same as having a government shutdown. Because Congress in the past has always lifted the debt ceiling before the Treasury has run out of money, no one knows for sure what will happen if Congress doesn’t act this time – what the Treasury and the Federal Reserve will do and how financial markets will react. If the debt limit is reached, the Treasury would likely consider prioritizing paying certain bills and delaying payments to others, generating concerns about which programs or services may be at risk. Experts warn that Medicare and Medicaid payments to providers and managed care companies might be delayed, as is possible for public health programs. Unless or until Yellen provides more information on the department’s plans, all ideas on potential responses and repercussions of reaching the debt limit are speculative. 

CMS Releases LatestMedicaid “Unwinding” Guidance 

At the beginning of the pandemic, the federal government prohibited states from kicking people off Medicaid, even if they were no longer eligible. As a result, Medicaid enrollment increased, and the uninsured rate dropped largely due to continuous Medicaid enrollment. However, the 2023Consolidated Appropriations Act (CAA) ended the Medicaid continuous coverage protection on March 31, 2023. It also established data reporting requirements and new conditions that states must meet to continue receiving enhanced federal Medicaid funding that has been extended in a phased-down manner through all of 2023. Beginning April 1, 2023, states may resume disenrollment of people who are no longer eligible for Medicaid, but only after the state has conducted a complete renewal, including examining eligibility for all categories of Medicaid. If you rely on Medicaid for care, it’s important to update your contact information, including your home address, phone number, and email, with the state from which you receive benefits. States have begun mailing renewal forms to homes. The federal government also requires states to contact you in another way — by phone, text message, or email — to remind you to fill out the form. If you are kicked off Medicaid, a special enrollment period will open for people who are unenrolled from Medicaid that started on March 31 and will last through July 31, 2024. People who lose Medicaid coverage will have up to 60 days to enroll after losing coverage. 

Most recently, the Centers for Medicare & Medicaid Services (CMS) released updated guidance explaining when states must attempt to recontact a beneficiary due to returned mail and let Medicaid agencies share beneficiary information with providers to encourage their patients to renew coverage. CMS also affirms that state Medicaid and Children’s Health Insurance Program (CHIP) agencies can share beneficiaries’ information with their providers as long as it’s to encourage their patients to complete a renewal. States can also authorize certain Medicaid and CHIP providers to help their patients complete a renewal. 

COVID-19 PHE (Public Health Emergency) Declaration Ends  

May 11, 2023, marked the expiration of the COVID-19 public health emergency (PHE), which was officially declared on January 31, 2020. CMS issued an updated fact sheet detailing which pandemic-era policies will and will not change with the end of the PHE. This update includes five new questions (on pages 7-11) on Medicare telehealth flexibilities. Fortunately, thanks to UMDF member advocacy, the 2023 Consolidated Appropriations Act (CAA) extends certain key telehealth flexibilities instituted during the PHE through Dec. 31, 2024. Additionally, CMS on May 12, 2023 – a day after the public health emergency ended – shifted direction and agreed to let hospital-employed physical therapists, occupational therapists, speech-language pathologists, diabetes self-management training, and medical nutrition therapy providers continue billing CMS for telehealth services as they have during the pandemic through the end of the calendar year 2023. 

NIH Nominee to Face Questions on Drug Pricing 

President Joe Biden announced the nomination of National Cancer Institute Director Monica Bertagnolli to lead the National Institutes of Health (NIH). Bertagnolli’s nomination is subject to Senate confirmation. While there is not yet a timeline for consideration of her nomination, Senate HELP Committee Chairman Bernie Sanders (I-Vt.) wrote President Biden last month to say that he “will strongly oppose any future nominee to a major federal health agency who is not prepared to lower the price of prescription drugs in this country significantly.” Republicans, including Ranking Member Bill Cassidy (R-La.), are expected to discuss with Bertagnolli the origins of the coronavirus pandemic and NIH grants to EcoHealth Alliance.