Resumption of Medicaid Redetermination Rules Will Be Problematic for Employers

Viewpoints from Craig Hasday

The Families First Coronavirus Response Act (FFCRA) required that Medicaid programs keep people continuously enrolled through the end of the month in which the COVID-19 public health emergency (PHE) ended.

Congress, as a part of the Consolidated Appropriations Act, 2023, stipulated the PHE will end on March 31, 2023. The PHE end date was recently amended to May 11, 2023, which means FFCRA continuous enrollment will end on that date as well.

The enhanced federal Medicaid matching funds program will also be scaled down through the end of 2023.

Almost 91 million Americans are covered under Medicaid. This represents an increase of almost 20 million people, or 27.9%, compared to pre-pandemic levels as a result of loosened eligibility rules and the FFCRA requirement. A study released by the Kaiser Family Foundation estimates that between five to 14 million people will be disenrolled during the 2023 unwinding period. This will include people who remain eligible but fail to complete the re-enrollment process.

What does this mean for employers?

Employees who waived coverage because they were covered under Medicaid may seek employer-provided coverage, since the loss of Medicaid would represent a qualifying event. Many new hires were not recertified and could be ineligible for Medicaid under state guidelines. States will be required to develop a plan to avoid disruption, which would undoubtedly include information on electing enrollment under their employer’s plan. Employees who became accustomed to extremely generous Medicaid benefits will now be subject to employer plan cost-sharing. Although superior in many ways, the increase in cost burden may lead to employee dissatisfaction.

Employers are advised to get ahead of this change.

They should review plan waivers and assess potentially impacted employees. EPIC advisors can help you design a strategy to proactively address this disruption. You are forewarned.

EPIC offers these opinions for general information only. EPIC does not intend this material to be, nor may any person receiving this information construe or rely on this material as, tax or legal advice. The matters addressed in this article and any related discussions or correspondence should be reviewed and discussed with legal counsel prior to acting or relying on these materials.