The resumption of Medicaid redeterminations following the conclusion of the COVID-19 Public Health Emergency (PHE) represents a significant disruption across multiple lines of business in the health care market. While there has been much uncertainty regarding the timing and pace of the resumption of redeterminations, 2023 is beginning to bring clarity to the myriad questions posed by states, employers, managed care organizations (MCOs), and other interested stakeholders. Begin with a brief review of the latest developments regarding the end of the PHE and resumption of Medicaid redeterminations. Then, transition to a panel discussion on the various impacts that key stakeholders are starting to see, and expectations for short-term and long-term impacts to programs, plans, and businesses. Specific topics of discussion are expected to include, but will not be limited to:
Various approaches states are taking to phase out continuous eligibility in their Medicaid programs under the maintenance of effort (MOE), which have been effective since early 2020.
How the approaches states have implemented are influencing enrollment shifts across markets, as Medicaid enrollees who no longer meet program eligibility seek coverage through state Children's Health Insurance Programs (CHIP), ACA plans, and large employer groups, or become uninsured population.
How do stakeholders in the Medicaid and large group markets expect these enrollment changes to influence the overall acuity of their enrolled population?
What are stakeholder expectations in the Medicaid and large group markets for changes in consumer behavior resulting from differences in covered benefits and cost sharing structures between programs?
What data and information are stakeholders using to inform their expectations?
Which key indicators are stakeholders monitoring as unwinding begins to identify vulnerabilities (e.g., ex parte rates, uninsured rates, coverage transition rates)?
What program/plan design changes and/or risk mitigation strategies, if any, are stakeholders putting in place due to the uncertainty surrounding Medicaid redeterminations on their program/products?
How are MCOs that operate both Medicaid and commercial lines of business approaching the uncertainty differently than MCOs that operate only Medicaid or only commercial business?
As appropriate, this list will be adjusted to account for additional developments related to the timing of the PHE expiration and (if applicable) actual experience from states, MCOs, and commercial plans. This session will also serve as a primer for the related virtual session in July 2023 where we will revisit the conversation with the latest updates and a more in-depth examination of the implication of PHE unwinding on pricing and cost considerations across market segments. Leave this session with a better understanding of the interplay of key elements of the PHE unwinding on the Medicaid and large group market segments, as well as how stakeholders in the Medicaid and large employer group markets are approaching the challenges created by PHE unwinding uncertainty.