As part of the COVID-19 public health emergency (PHE) enacted by Congress, Medicaid programs were required to keep individuals continuously enrolled in the program to receive enhanced federal funding (typically, Medicaid requires an annual eligibility renewal). The continuous enrollment requirement was decoupled from the PHE through the Consolidated Appropriations Act (passed in late 2022) and is set to expire on April 1. States have some flexibility in how they “unwind” the automatic, continuous health coverage provisions that have been in place. To help make sense of how New York is approaching the unwind, Rockefeller Institute Senior Fellow for Health Policy Courtney Burke is joined by Amir Bassiri, deputy commissioner and Medicaid director at the New York State Department of Health, Danielle Holahan, executive director of New York State of Health, and Lisa Sbrana, director of the Division of Eligibility and Marketplace Integration at the New York State Department of Health.
Guests:
Courtney Burke, senior fellow for health policy, Rockefeller Institute of Government
Amir Bassiri, deputy commissioner and Medicaid director, New York State Department of Health
Danielle Holahan, executive director, New York State of Health
Lisa Sbrana, director, Division of Eligibility and Marketplace Integration, New York State Department of Health
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Transcript was generated using AI software and may contain errors.
Alexander Morse 00:04
Welcome to Policy Outsider presented by the Rockefeller Institute of Government. I’m Alex Morse. On May 11 2023, the public health emergency, or PHE, that waived various regulations designed to ensure more flexibility in the delivery of health care and access to health systems during the pandemic will expire, including the flexibility that helped provide continuous Medicaid coverage for millions of people in the United States. In anticipation of the expiration of the public health emergency, Congress passed legislation in late 2022, called the Consolidated Appropriations Act of 2023, that decoupled the public insurance coverage provisions from the larger public health emergency. Public insurance programs include such services as Medicaid, the Children’s Health Insurance Program, and other health programs sometimes known as the Essential Plan or Basic Health Plan. To prepare for the expiration of the public health emergency, all states are required to develop a plan for unwinding the automatic continuous health coverage provisions that had previously been in place. To explore how New York is approaching the public health insurance unwinding, Courtney Burke, senior fellow for health policy at the Rockefeller Institute of Government, will be joined by three health experts at various New York State agencies that are working in concert to inform New Yorkers on the pending changes to health coverage and ensure that everyone entitled to Medicaid will keep their benefits and services uninterrupted. Coming up next.
Courtney Burke 01:40
Welcome to Policy Outsider presented by the Rockefeller Institute of Government. I’m Courtney Burke, senior fellow for health policy at the Rockefeller Institute. Today’s episode will focus on New York’s unwinding of its public health emergency, how it will impact health coverage for millions of New Yorkers and what the state is doing to prepare for the impending shift for health insurance coverage. To help us break it all down, we are joined today by Amir Bassiri, deputy commissioner and Medicaid director at the New York State Department of Health, Danielle Holahan, executive director at New York State of Health, and Lisa Sbrana, director of the Division of Eligibility and Marketplace Integration at the New York State Department of Health. Thank you all for being here today and welcome. Now, Medicaid is such an important program. Coverage is a vital part of the state’s overall insurance coverage. We’ve previously done a podcast with Amir about this, who is the state’s Medicaid director, which highlighted some facts about the number of people who rely on public health insurance coverage programs, which is over 8 million people. So, a very significant program. Danielle, I think with this first question, we’d like to start with you. Can you break down how many people are currently covered under which programs?
Danielle Holahan 02:55
Absolutely. Our coverage levels in the state are at historic highs. We have 7.7 million people enrolled through the Medicaid program. And that is both through the New York State of Health Marketplace and through local district offices. So, 5.3 million of the 7.7 are enrolled her New York State of Health and 2.4 million are enrolled through the local district social services offices. Then we have an additional 1.1 million people enrolled in our state’s Basic Health program, which we call the Essential Plan here. And then we have 380,000 enrolled in the state’s Child Health Plus program. So altogether, over 9 million people enrolled in these programs.
Courtney Burke 03:38
Wow, very significant. Tell us a little bit more about New York State of Health, what it is, what its role is in the public health unwinding policy discussions.
Danielle Holahan 03:51
Sure. So, New York State of Health is New York’s official health plan marketplace were authorized in the federal Affordable Care Act. And we were established in 2012. So, New York has designed its marketplace as a fully integrated marketplace that’s across public and commercial insurance products. So, we enroll individuals in Medicaid, Essential Plan, Child Health Plus, and qualified health plans, with and without subsidies. It’s really a one stop shop for insurance coverage. Consumers come to us. We determine their eligibility for programs, they’re displayed a set of plan options and they enroll in coverage. So that’s New York State of Health in a nutshell. Why we’re and how we’re relevant to the public health emergency unwind, about 83% of the individuals who will need to be redetermined had their coverage through New York State of Health. So, we’re a big piece of the unwind. And I think one thing, as I mentioned, the integrated structure, what sets us up well for the unwind is that as we always do, when we determine somebody’s eligibility, if they’ve become eligible for one of our other programs, we can seamlessly enroll them into that program. And if they like they can even stay with the same insurer. So that’s a really nice feature of an integrated marketplace. The other thing about New York State of Health is that more than 99% of our applications get a real time eligibility determination. So, there’s some really nice features of New York’s marketplace. And I think that will set us up well for this unwind effort. Some of the other things that we’ve been doing to prepare, we’ve been working to update our eligibility and enrollment systems, we need to go back to the rules as they were before we were in this COVID continuous coverage period. And we’ve been doing a lot around our communications efforts to make sure people are ready and are aware of what’s coming. So just that’s, you know, how New York State of Health is involved.
Courtney Burke 05:55
Yeah, this is probably one of the most important things that New York State of Health has been involved in with this current unwinding since the inception of the New York State of Health. So, I wanted to talk a little bit more about the unwinding. The federal government is having the state go back to regularly requiring that individuals prove their eligibility for coverage for these programs, that a lot of that was waived during the pandemic. So, I know the state is doing this redetermination in waves. And I think our listeners would value knowing a little bit more what that timeframe looks like and what the process is from start to end, and how it will be rolled out. So, I think Lisa, you probably are the best person because you’re the most involved in the day to day on this type of thing.
Lisa Sbrana 06:41
Sure, so the state or New York rather, is taking the maximum amount of time allowed to conduct the rollout. It’ll take about a year to renew everyone in the three programs in their coverage. And the way we’re basing the rollout is really going back to when somebody was determined eligible. Eligibility is based on a 12-month cycle, normally, during the public health emergency, of course, no one has had to re determine their eligibility. So, the redetermination process will take place across the state based on the month of when eligibility for coverage ends. So, we’re starting with the first end dates will be June 30 of 2023. So, if anybody has eligibility and dates prior to June 30, they will continue to be extended for 12 months, just as they have been during the entire public health emergency. And the first group who will need to respond to an eligibility packet will be in June.
Courtney Burke 07:55
I think that’s really important information for listeners, because people are unsure exactly when they might be at risk of losing their coverage. And it’s not going to be April 1, it’s not going to happen the soonest and not for everybody, until June. So that was very helpful clarification. So, I know that the state has worked to link information about people who are currently on these programs, and who may be eligible going forward with other data sources to make the determination of eligibility much quicker and automated. Can you tell us a little bit more about how that works, and what data is being used to make those determinations.
Lisa Sbrana 08:34
So as Danielle was saying, you know, in New York State of Health, we’ve worked really hard to make sure that we have the easiest process available to individuals. And part of that process is hitting up against federal and state data sources. So, what if someone is employed, we can see their employment data, they don’t have to provide that to us. If individuals have social security, retirement or disability income, that is also available to us. Unemployment data will be, is also regularly available to us. On the district side, so if an individual is eligible because they’re over the age of 65, or because of a disability, on that side, also we have access to information from social security, and also pensions. So, if that income doesn’t change, those individuals will be automatically determined, their eligibility will be automatically determined. As a an additional easement, for the process, we’re also looking are working with the federal government to utilize SNAP data so that individuals who are in that program, whether they’re enrolled through New York State of Health are enrolled through a local district, if they also have SNAP, we are looking to have the ability to match up against that data and also not require those individuals to have to do anything. So, we’re trying to automatically redetermined as many people as possible if we have the data sources to do that.
Courtney Burke 10:17
That’s really great. It makes it easier for both sides if you have that data already, but I know there will be instances where there may not be a good source to help automatically determine eligibility. So, in those instances, curious about what process will be used, and whether counties will be involved as they sometimes have been in the past with helping determine that eligibility.
Lisa Sbrana 10:38
Yes. So, on both, in both systems, whether the individual is enrolled through a local district, or they’re enrolled through New York State of Health, if we can’t verify their income based on data sources, they’ll receive a notice letting them know that they need to come back. So, on the district side that notice will ask individuals to attest to their income and send that attestation form back to the district. And then the district will determine their eligibility. On the New York State of Health side, the notice asked people to come back to their account and complete that information. And when I say that people need to come back, they don’t need to come back themselves. We have 1000s, literally 1000s of assisters across the state, available and accessible to individuals to help them through the process.
Courtney Burke 11:33
That’s great. It sounds like you’re well positioned both with automated processes and with real people to help with these processes going forward, I want to take a step back a little bit and think about the financial impact. So, I know we’ve talked about eligibility and what it’s like from a consumer point of view when this is all going to take effect. But with the start of the public health emergency states were given a financial incentive to provide this coverage to begin with and do it continuously. Now it looks like that funding is going to phase down. So, Amir, as the as the keeper of the state Medicaid program who looks at these finances, can you tell us a little bit more about the timeframe for the wind down and what the financial incentives will look like going forward?
Amir Bassiri 12:20
Absolutely. And just to build off what you shared, Courtney, it is true since the onset of the public health emergency going back to January of 2020, the state has received 6.2% of increased federal match on the Medicaid program as a condition of the continuous coverage requirements that we’ve maintained, leading up to the unwind. So, in December of last year, the federal government or Congress I should say, passed the Consolidated Appropriations Act, which effectively outlined what that based financial incentive would be. Previously, it had been assumed that when the unwind started, that 6.2% went away in one fell swoop. What Congress did was they de-linked the continuous coverage requirement from the public health emergency and offered a quarterly phase down of the 6.2% through the end of the year. So, beginning April 1 of this year for that till June 30, that 6.2% goes to 5%. And then in the subsequent quarter, July to September, the 5% goes to 2.5%. And in the last quarter of this calendar year, October to December 2.5%, goes to one and a half. And then starting January of 2024. There is no more enhanced federal funding, even though we will still be in the unwind process, as Lisa mentioned earlier, that will end in for New York in May of 2024. But we do get this nine-month period of phase down enhanced federal funding, which is very much appreciated and needed, given the size of the Medicaid enrollment and the length of time it will take us to fully complete the outline.
Courtney Burke 14:26
It’s helpful to know Yeah, go ahead.
Amir Bassiri 14:28
I wanted to add there are conditions to receive this enhanced phase down federal funding, and that was also outlined in this federal bill that Congress passed in December. The conditions are essentially that the state must be in compliance with eligibility redeterminations as outlined in the law and may include some temporary flexibility that the federal government would provide to ensure that we are in compliance with every rule and those are called E-14 waivers. We also need to make sure that we attempt to ensure that we have the most up to date contact information for our members, including the mailing address, phone numbers, emails. And we are not allowed to disenroll any individual based on return mail or procedural disenrollments. We are required to make a good faith effort to contact the individual and use all the modalities available to us to ensure that a member receives the information about the renewal. And we can’t disenroll them for procedural reasons. So, there are some conditions of receiving this funding that we have no, no concerns about meeting. And the maintenance of effort that was established under the initial law is still in place, there are no reduction to benefits, or limits to services during the calendar year.
Courtney Burke 15:54
Well, that brings up a good point and a concern about people who may lose coverage. And you’ve already explained how much you’re doing to automatically keep people enrolled by looking at different datasets and seeing if they still would qualify. Also, outreach at the ground level to people about the eligibility. But I am wondering, and it may be hard to project this, but I’m sure that that you have how many people are expected to lose coverage because they no longer qualify, which is obviously different from the number of people that just forget, are unaware that they’re supposed to do some type of eligibility redetermination. So, what are the numbers look like in terms of people potentially losing coverage, and I know you’re doing a lot to minimize that. But tell us more about that.
Lisa Sbrana 16:41
Right. So out of the 8 million people that we will be redetermining, we’re anticipating that about 100,000 of them could become uninsured. Some of them could become uninsured, because they’re no longer eligible. So, when we say no longer eligible right now, what we’ve been doing is maintaining individuals with coverage who normally wouldn’t be maintained. So, for example, individuals who have third party coverage, so other coverage through an employer or a coverage through Medicare, we have had easements in place that maintain those individuals in their managed care plans during this process. So, individuals with employer-based insurance, many of them, if they are still eligible, then Medicaid would wrap around that coverage. So those folks would still be eligible with us. But it’s expected that a number of them will no longer be Medicaid eligible. And for the other programs, employer-based insurance is minimum essential coverage, which makes them actually ineligible for those other those other type forms of coverage. So that’s actually the largest group, is there’s an expectation that there’s a certain percentage of that 100,000, who actually have employer-based coverage and are no longer, would no longer be eligible for one of our programs because of that. Some people will also, sorry, as Amir was saying, you know, during the unwind, we or during the public health emergency, we of course, haven’t disenrolled anyone, but during the unwind after the mitigation period is over, if people don’t respond to their renewal, that could be another reason why someone isn’t found eligible. So, it will be really important that folks respond to those notices.
Courtney Burke 18:00
That’s, that’s great to know. And along those lines, I remember when the insurance exchange was originally launched the New York State of Health, the marketing that went into that to make sure people knew that this was a new program. So, this time around, you definitely are looking to do the same. So, what type of public education and marketing and outreach is planned now to help minimize the number of people losing coverage?
Danielle Holahan 19:05
Great question. And you’re right, we have been doing a lot in this area, the most since we launched around just building awareness, not of the marketplace, but of what’s coming. So, we actually started a year ago, because at that point, we didn’t know when the continuous coverage requirements would end. And we wanted to do everything we could to get people, you know, focused on this and what they could do at the time, which was update their contact information, which is key. We know a lot of people moved over the last couple of years, and we want to still be able to reach them when it is time to renew. And we also want them to know that there will be something they need to do to keep their coverage. So, we’ve been out there advertising. Hopefully your listeners have seen these ads. And so that’s the messaging that we’ve been doing for quite some time now with a public education campaign, and we will shift yours as we’ve been talking about now that we’re moving into this redetermination phase, we’ll tell the messaging will change. To tell people, when you hear from us, you need to take action to keep your coverage. So that’s sort of how we’re doing the paid advertising piece of things. And the other part that we’ve been doing, and we’ve been very active and engaged, of course, coordinating with Amir and Lisa, because this is not just New York State of Health, this is the districts too. There’s a number of consumer education materials that we have been developing: factsheets, social media posts, posters, call scripts, anything we can think of that we think would be helpful for our partners, to be telling people what they need to do and when and how to, you know, how to contact us, whether it’s through our customer service center, the enrollment assisters that Lisa referenced, how to check what their renewal date is things of that nature. So, it’s been a very robust public education and awareness campaign. And I’ll mention what we are referring to as our digital toolkit on New York state of Health’s website, and also the Medicaid website. If you go to nystateofhealth.ny.gov and enter anything related to this unwind public health emergency, you will come to this page that we’ve dedicated, and we continue to update, where we put all of these fact sheets and consumer education materials. So, I just want to make sure people know that that’s there. And we encourage people to use it. We’ve been talking with various stakeholders, whether it’s plans, whether it’s health centers, our delegation, anywhere people would call with questions about this to make sure they’re armed with the same information and people know what to do and where to go. So, it’s been quite an effort, and it’ll continue. But this is an all-hands-on deck kind of operation. The other thing we’ve been doing, and we’re grateful that there’s been some foundation support and money out there, to our enrollment assisters to support the outreach effort, because that is key. We need to be arming them with these materials and supporting in that effort in the communities. So, we’re trying to engage with every partner we can think of to spread the word and extend our reach. So that’s what we’ve been doing on the public education front.
Courtney Burke 22:25
No, that’s great. That’s pretty extensive. And there is a lot of information out there. One of the things that I’ve read and let me be clear about this. It’s not about New York, it’s actually about some states in the South. But I had heard that they’re reinstating new requirements related to obtaining Medicaid coverage. Just wanted to check and make sure whether New York is contemplating any of these new requirements or not.
Amir Bassiri 22:48
So, I can take that one, Courtney. I mean, I think I know the states you’re referring to, and I can tell you definitively we are not employing the same strategies as they are. There will not be new requirements imposed on behalf of Medicaid members to retain their eligibility. We’ve actually been proactive in the last 12 to 24 months in anticipation of the unwind in trying to align some of our eligibility level across populations to ensure that as we go through this process, that we maintain eligibility to the greatest degree possible. And some of those things we did in last year’s budget, increasing the income levels for all adults through 138% of the federal poverty level, expanding the Medicare Savings Program, eliminating premiums and the Child Health Plus program. All actions taken to mitigate disruption as we go through this process. So, there will not be new impositions on our members. We tried to employ a strategy that is as facilitating and maintain coverage as possible. That’s why as Lisa said, we’re keeping this cycle the same. And we’re keeping people on the on their same enrollment cycle. We’ve leveraged some of the efficiencies we’ve gained through the PHE, by keeping members in the New York State of Health, to ease the burden on districts as they go through this process, or there’s no unanticipated increases in volume of potential applicants or renewals. So, we’ve really taken a much different approach than those shapes in the south. And I think our federal partners appreciate that.
Courtney Burke 24:34
That’s very helpful to know. And thank you for clarifying that. We’ve covered a lot today. I really appreciate all the details that each of you have provided on the rollout, the eligibility determinations, what this means for the state financially, what you’re doing to market. So, is there anything we haven’t covered today that you think our listeners should know about the public health unwinding as it relates to public insurance coverage?
Lisa Sbrana 24:58
I think Danielle mentioned this earlier, but we can’t stress enough how important it is and how much we want people to come back. If their address has changed or their email address has changed, or their phone number has changed, if any of their contact information has changed, we really want that information because it’s our desire that no one come out of this without insurance and that everybody either maintain the coverage that they’re in or if they’re eligible for something else that we can get them into it.
Courtney Burke 25:29
Great. Danielle, anything else you want to add?
Danielle Holahan 25:33
I’ll just remind everybody about the materials and the website where they can go to nystateofhealth.ny.gov and search for public health emergency, search for unwind. But there is a host of materials there, how to videos, fact sheets, etc. So, we just encourage people to make use of those and help us spread the word. We as everybody here has said our goal here is that people retain coverage. We don’t want to see an increase in our uninsured rates in the state of New York.
Courtney Burke 26:03
Right. Well, Danielle, Lisa and Amir, thank you for joining us today. Thank you for the work that you’re doing and best of luck with the unwind over these next few months.
All 26:13
Thanks very much
Amir Bassiri 26:15
Thanks for the opportunity.
Alexander Morse 26:21
Thanks again to Courtney Burke. Amir Bassiri, Danielle Holahan and Lisa Sbrana, for sharing what they’re doing to prepare for the public health emergency unwinding and how they are working to keep millions of New Yorkers informed about their health insurance coverage and provide continued services. If you’d like to learn more about these pending changes, please visit nystateofhealth.ny.gov. There you will find additional information about New York Medicaid, Child Health Plus and the Essential Plan, and any changes as it relates to the public health emergency expiration. While there, you will have the opportunity to update your contact information and find assistance to determine your health insurance needs. If you liked this episode, please rate subscribe and share. It will help others find the podcasts and help us deliver the latest in public policy research. All of our episodes are available for free wherever you stream your podcasts and transcripts are available on our website. Special thanks to Rockefeller Institute staff Joel Tirado, Heather Trela, and Laura Schultz for their contributions to this episode. Thanks for listening. I’m Alex Morse. Until next time.
Policy Outsider is presented by the Rockefeller Institute of Government, the public policy research arm of the State University of New York. The Institute conducts cutting edge, nonpartisan public policy research and analysis to inform lasting solutions to the challenges facing New York State and the nation. Learn more at Rockinst.org or by following at Rockefeller inst. That’s Rockefeller i n s t on social media. Have a question comment or idea? Email us at [email protected].
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