On July 27, 2022, the Medicaid and Children’s Health Insurance Program Payment Advisory Commission (MACPAC) held a public meeting to provide an update on the status of Medicaid and CHIP coverage during and after the public health emergency (PHE). Topics discussed included fiscal implications of unwinding the PHE, addressing uncertainty for states, and Centers for Medicare & Medicaid Services (CMS) and state preparation to address potential post-PHE loss of coverage.
Between February 2020 and February 2022, enrollment in Medicaid and CHIP increased by 24 percent. At the end of the PHE, 5 to 14 million individuals may disenroll, though some may be eligible for coverage under other sources. MACPAC is dedicated to reducing potential loss of coverage for Medicaid and CHIP beneficiaries.
Fiscal Implications of Unwinding the PHE
During the PHE, states have received approximately $100.4 billion in funding due to the enhanced Federal Medical Assistance Percentage (FMAP), which is used to determine the matching funds rate allocated annually to CHIP. At the end of the PHE, enrollment and total spending growth will likely be reduced, and the state share of Medicaid spending will likely grow with the conclusion of the enhanced FMAP. There has also been concern that the end of the enhanced match would cause states to unwind quickly. To address these concerns, one commissioner suggested MACPAC make a recommendation for phasing down the enhanced FMAP to avoid a funding cliff. Some commissioners supported this suggestion but noted that the impact of the enhanced FMAP ending is dependent on state budgets and fiscal health.
Uncertainty of PHE End Impacts State Planning Efforts
The state response to the eventual end of the PHE has been variable. MACPAC noted that states and stakeholders have been concerned that the uncertainty surrounding the end of the PHE has hindered their ability to plan; however, other states and stakeholders have said they have developed unwinding plans and are making broader system and process changes. While additional advanced notice or providing a certain date for unwinding would give states more time to prepare, several states indicated that additional notice would not substantially improve preparation efforts. States also noted that shifting the end date of the PHE causes states to start and stop preparation and burdens state resources.
MACPAC Outlines Priorities in Preparation for Upcoming Meeting
The next MACPAC meeting is scheduled for September 2022, when the regular meeting cycle begins. Commissioners discussed priorities in preparation for the meeting, including continuing to connect with states and stakeholders and monitoring publicly available information on unwinding data. Commissioners expressed interest in analyzing procedural enrollment data, to examine whether there are specific populations being disproportionately impacted by the unwinding process. Some commissioners asked about the best way to track continuity of care and noted that this may be an important issue for the September meeting.
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This Applied Policy Summary was prepared by Emma Hammer with support from the Applied Policy team of health policy experts. If you have any questions or need more information, please contact her at ehammer@appliedpolicy.com or at 202–558–5272.