As I mentioned on Tuesday, the chattering classes in health policy circles are raising alarms about Medicaid redeterminations. Yes, it is a big deal. We have never tried to redetermine the eligibility of 91M people in the space of 12 months in any program, not to mention one as complex as Medicaid. However, I question how significant an impact the redeterminations will have on actual insurance coverage of people who need health care services, regularly or at all.
The cries that have gone up about loss of coverage seem to assume that the Medicaid program has assumed a shift in care during the COVID pandemic. As one example, Ascension's payer mix, like that of HCA, CommonSpirit and Providence does not reflect that narrative. Aside from a modest bump in 3Q 2021, Ascension's Medicaid patient revenue has hovered around 14% of total for the last five-years.
In other words, the expansion of Medicaid coverage has not really resulted in a corresponding shift away commercial that presumably would have been reduced during the pandemic...or something. The exception is behavioral health care services. More on that later.
The warnings from the health policy crowd are for something else then. Based on observing the insurance coverage wars of the late 90s, I expect the game plan is to warn of coverage losses - something that is almost certain - and move for state level injunctions, federal reviews, etc., when disenrollment comes to pass. The process then, could become attenuated beyond the already unrealistic 12-month redetermination period.
The chaos will likely matter little to providers, save behavioral, but could create tension between MCOs and states as the reduced FMAP causes some budgetary friction.
Let me know what you think.
Emily Evans
Managing Director – Health Policy
Twitter
LinkedIn
