The Medicaid Unwind

The public health emergency preventing people from loosing Medicaid coverage ends in spring 2023. While not everyone will lose coverage right away, Iowa is being open that they are heavily front-loading redeterminations.

The Medicaid unwind is being called the biggest impact to Medicaid since the Affordable Care Act. As part of the public health emergency, someone could not be cut off Medicaid even if they went over income or did not submit renewal documents. This helped individuals to have continuous coverage during the pandemic.

What is happening with Medicaid coverage?

The public health emergency preventing people from losing Medicaid coverage ends in spring 2023. In March 2020, there were 690,000 Iowans on Medicaid. Presently there are 875,000 Iowans on Medicaid. All states have until the end of 2023 to rescreen all individuals enrolled in Medicaid for eligibility. While not everyone will lose coverage right away, Iowa is being open that they are heavily front-loading redeterminations.

Iowa Health and Human Services (IHHS) is making every effort to reach out to individuals to renew this spring. But, if someone has moved since March 2020 and not updated their address, they will NOT get these notifications. IHHS is also trying to use social media and email as means of communication.

Which Medicaid policies will be renewed?

Starting February 2023, anyone on a Medicaid plan that can be “passively renewed” will be. This means that they marked on their previous application the desire to be renewed, signed a release authorization to automatically verify information, and filed taxes in the past year. Those individuals can be passively renewed and will be sent a letter of approval or denial without having to fill out new paperwork.

For the many who cannot be passively renewed, the first round of renewal verifications will be due back April 5, 2023. If someone does not respond to the renewal request, he or she will then get a letter stating that Medicaid will end April 30, 2023. Also, if someone is now over income guidelines, coverage will end for the first round of verifications April 30th. If a Medicaid ends, a person will have a sixty day special enrollment period to purchase insurance through the federal marketplace if desired. Redeterminations will continue throughout 2023 until all Iowans enrolled in Medicaid are re-assessed for present eligibility.

New Managed Care Organization (MCO) joining Iowa Medicaid

In the midst of the renewals, a third Managed Care Organization (MCO) is joining Iowa Medicaid. MCOs are the companies contracted by the state to provide Medicaid coverage. Currently, the two companies are Amerigroup and Iowa Total Care. Molina will be coming onboard in spring of 2023. Some Iowans will be reassigned during the renewal process to Molina.

In the end, the three MCOs will have roughly the same number of patients. This could cause confusion. Also, some providers may take awhile to contract with Molina. This would mean the possibility of having to find a new doctor if he or she does not accept the new insurance. Everyone reassigned to a new MCO will be mailed paperwork giving them the opportunity to switch back to their original MCO.

What to Expect

I believe the Unwinding will impact His Hands clinic in several ways. First, there will be more calls with questions. People will receive letters from Medicaid they don’t understand. They may be afraid to access traditional healthcare out of fear of getting a bill.

Secondly, there will be an increased urgent demand for patient appointments. Patients will show up to an appointment at their primary care provider or urgent care and discover that their insurance has been cut off. They will need somewhere to go for medical care while they submit a new application to Medicaid. Others may be over income for state insurance and need care longer-term.

And finally, what I anticipate the biggest problem to be, is medication access. People will be at the pharmacy when they realize their Medicaid has been cut off. They will be unable to pick up the medication, unless they have funds to cash pay for it. I expect them to call the clinic then wanting medications right away. Unfortunately, we are limited in the types of medications we carry here at the clinic. Some are just too expensive for us to dispense, and we do not give out controlled substances.

A Rocky Road is Ahead

It could be a rocky road as the Medicaid unwinding occurs. Our role is to encourage people to keep their addresses up to date with Iowa Health and Human Services. If a moment of panic arises for a patient, we just need to remember how we would feel. It would be scary to find out at an appointment or pharmacy that we no longer had insurance coverage.

We are working diligently to anticipate the increase in needs and phone calls here at the clinic. We are blessed to be able to provide medical services to the community. It is our goal to be a resource for information during the unwinding process.

If you are one of the many people impacted by this change, please don’t hesitate to reach out to us for support. We’re here to help.

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